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Publisher Copyright: © 2021 International Society of Nephrology The authors would like to thank the patients and staff of all the dialysis and transplant units who have contributed data via their national and regional renal registries to the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry. In addition, we would like to thank the persons and organizations listed in the paragraph "AFFILIATED REGISTRIES" for their contribution to the work of the ERA-EDTA Registry. The authors are grateful to all nephrologists and kidney transplant surgeons who completed "The Effect of Differing Kidney Disease Treatment Modalities and Organ Donation and Transplantation Practices on Health Expenditure and Patient Outcomes" Nephrologist survey. In addition, we would like to thank all colleagues who pretested the survey, provided advice about the ethical approval in their country, or helped to distribute the survey in their country or personal network. This study was funded by the European Union (grant PP-01-2016) and ERA-EDTA. Among others, we are grateful for support from Austria (R. Kramar and R. Oberbauer), Belarus, Belgium (F. Collart), Croatia (I. Bubic, M. Bušić, M. Dragović, and S. Živčić Ćosić), Cyprus, Czech Republic (I. Rychlik and V. Tesař), Denmark (J. Heaf and S. Schwartz Sørensen), Estonia, Finland (P. Finne and V. Rauta), Germany (M. Lingemann and C. Wanner), Greece (T. Apostolou, E. Dounousi, and G. Moustakas), Hungary (O. Deme, S. Mihaly, and G. Reúsz), Ireland (W. Plant), Italy (G. Brunori, C. Carella, P. di Ciaccio, and M. Postorino), Latvia (A. Petersons), Malta (J. Buttigieg), Moldova (A. Tanase), the Netherlands (F. van Ittersum and S. Logtenberg), North Macedonia (G. Spasovski), Norway (A. Åsberg, M. Dahl Solbu, and A. Varberg Reisæter), Poland (S. Dudzicz and M. Nowicki), Romania (L. Gârneaţă and L. Tuta), Russia (H. Zakharova), Serbia (R. Naumovic), Slovakia (V. Spustova), Slovenia (J. Buturovic Ponikvar and D. Kovac), Spain (C. Alberich, J. Comas, M. del Pino y Pino, M. Ferrer Alamar, and B. Mahillo), Sweden (M. Evans), Switzerland (P. Ambühl and U. Huynh-Do), Turkey (M. Arici), Ukraine (M. Kolesnyk), and United Kingdom (S. Fraser and G. Lipkin); and from the following organizations: EKITA (I. Bellini and R. Langer), ERA-EDTA (F. Trebelli), EuroPD (S. Davies), and Eurotransplant (P. Branger, M. van Meel, and U. Samuel). Affiliated registries. Albanian Renal Registry (M. Barbullushi, A. Idrizi, and E. Bolleku Likaj); Austrian Dialysis and Transplant Registry (OEDTR) (R. Kramar); Belarus Renal Registry (K.S. Komissarov, K.S. Kamisarau, and A.V. Kalachyk); Dutch-speaking Belgian Society of Nephrology (NBVN) (M. Couttenye, F. Schroven, and J. De Meester); French-speaking Belgian Society of Nephrology (GNFB) (J.M. des Grottes and F. Collart); Renal Registry Bosnia and Herzegovina (H. Resić, Z. Stipancic, and N. Petkovic); Bulgaria (E.S. Vazelov and I. Velinova); Croatian Registry of renal replacement therapy (CRRRT) (I. Bubić and M. Knotek); Cyprus Renal Registry (K. Ioannou and all of the renal units providing data); Czech Republic: Registry of Dialysis Patients (RDP) (I. Rychlík, J. Potucek, and F. Lopot); Danish Nephrology Registry (DNS) (J.G. Heaf); Estonian Society of Nephrology (Ü. Pechter, K. Lilienthal, and M. Rosenberg); Finnish Registry for Kidney Diseases (P. Finne, A. Pylsy, and P.H. Groop); France: The Epidemiology and Information Network in Nephrology (REIN) (M. Lassalle and C. Couchoud); Georgian Renal Registry (N. Kantaria and Dialysis Nephrology and Transplantation Union of Georgia); Hellenic Renal Registry (N. Afentakis); Icelandic ESRD Registry (R. Palsson); Israel National Registry of Renal Replacement Therapy (R. Dichtiar, T. Shohat, and E. Golan); Italian Registry of Dialysis and Transplantation (RIDT) (A. Limido, M. Nordio, and M. Postorino); Latvian Renal Registry (H. Cernevskis, V. Kuzema, and A. Silda); Lithuanian Renal Registry (I.A. Bumblyte, V. Vainauskas, and E. Žiginskienė); Macedonian Renal Registry (M. Nedelkovska, N. Dimitriova, and O. Stojceva-Taneva); Norwegian Renal Registry (T. Leivestad, A.V. Reisæter, and A. Åsberg); Polish Renal Registry (G. Korejwo, A. Dębska-Ślizień, and R. Gellert); Portuguese Renal Registry (F. Macário and A. Ferreira); Romanian Renal Registry (RRR) (G. Mircescu, L. Garneata, and E. Podgoreanu); Russian Renal Registry (N. Tomilina, A. Andrusev, and H. Zakharova); Renal Registry in Serbia (N. Maksimovic, R. Naumovic, all of the Serbian renal units, and the Serbian Society of Nephrology); Slovakian Renal Registry (V. Spustová, I. Lajdová, and M. Karolyova); Spanish RRT National Registry at Organización Nacional de Trasplantes (ONT), Spanish Regional Registries, Spanish Society of Nephrology (SEN), and the regional registries of Andalusia Sistema de Información de la Coordinación Autonómica de Trasplantes de Andalucia (SICATA) (P. Castro de la Nuez [on behalf of all users of SICATA]), Aragon (F. Arribas Monzón, J.M. Abad Diez, and J.I. Sanchez Miret), Asturias (R. Alonso de la Torre, J.R. Quirós, and Registro de Enfermos Renales Crónicos de Asturias [RERCA] Working Group), Basque country (UNIPAR) (Á. Magaz, J. Aranzabal, M. Rodrigo, and I. Moina), Cantabria (J.C. Ruiz San Millán, O. Garcia Ruiz, and C. Piñera Haces), Castile and León (M.A. Palencia García), Castile–La Mancha (G. Gutiérrez Ávila and I. Moreno Alía), Catalonia (RMRC) (E. Arcos, J. Comas, and J. Tort), Extremadura (J.M. Ramos Aceitero and M.A. García Bazaga), Galicia (E. Bouzas-Caamaño), Community of Madrid (M.I. Aparicio de Madre), Renal Registry of the Region of Murcia (C. Santiuste de Pablos and I. Marín Sánchez), Navarre (M.F. Slon Roblero, J. Manrique Escola, and J. Arteaga Coloma), and the Valencian region (REMRENAL) (M. Ferrer Alamar, N. Fuster Camarena, and J. Pérez Penadés); Swedish Renal Registry (SNR) (K.G. Prütz, M. Stendahl, M. Evans, S. Schön, T. Lundgren, and M. Segelmark); Swiss Dialysis Registry (P. Ambühl and R. Winzeler); Dutch Renal Registry (RENINE) (L. Heuveling, S. Vogelaar, and M. Hemmelder); Tunisia, Sfax region (F. Jarraya and D. Zalila); Registry of the Nephrology, Dialysis and Transplantation in Turkey (TSNNR) (G. Süleymanlar, N. Seyahi, and K. Ateş); Ukrainian Renal Data System (URDS) (M. Kolesnyk, S. Nikolaenko, and O. Razvazhaieva); UK Renal Registry (UKRR) (all the staff of the UKRR and of the renal units submitting data); and Scottish Renal Registry (SRR) (all of the Scottish renal units). ERA-EDTA Registry committee members. C. Zoccali, Italy (ERA-EDTA President); Z.A. Massy, France (Chairman); F.J. Caskey, United Kingdom; C. Couchoud, France; M. Evans, Sweden; P. Finne, Finland; J.W. Groothoff, the Netherlands; J. Harambat, France; J.G. Heaf, Denmark; F. Jarraya, Tunisia; M. Nordio, Italy; and I. Rychlik, Czech Republic. ; The aims of this study were to determine the frequency of dialysis and kidney transplantation and to estimate the regularity of comprehensive conservative management (CCM) for patients with kidney failure in Europe. This study uses data from the ERA-EDTA Registry. Additionally, our study included supplemental data from Armenia, Germany, Hungary, Ireland, Kosovo, Luxembourg, Malta, Moldova, Montenegro, Slovenia and additional data from Israel, Italy, Slovakia using other information sources. Through an online survey, responding nephrologists estimated the frequency of CCM (i.e. planned holistic care instead of kidney replacement therapy) in 33 countries. In 2016, the overall incidence of replacement therapy for kidney failure was 132 per million population (pmp), varying from 29 (Ukraine) to 251 pmp (Greece). On 31 December 2016, the overall prevalence of kidney replacement therapy was 985 pmp, ranging from 188 (Ukraine) to 1906 pmp (Portugal). The prevalence of peritoneal dialysis (114 pmp) and home hemodialysis (28 pmp) was highest in Cyprus and Denmark respectively. The kidney transplantation rate was nearly zero in some countries and highest in Spain (64 pmp). In 28 countries with five or more responding nephrologists, the median percentage of candidates for kidney replacement therapy who were offered CCM in 2018 varied between none (Slovakia and Slovenia) and 20% (Finland) whereas the median prevalence of CCM varied between none (Slovenia) and 15% (Hungary). Thus, the substantial differences across Europe in the frequency of kidney replacement therapy and CCM indicate the need for improvement in access to various treatment options for patients with kidney failure. ; Peer reviewed