Chronic Kidney Disease Burden Across EU/EEA Countries: Structural Determinants, Mortality Convergence and Comparison of Global Burden of Disease Estimates with Vital Registration Data

Background and Objectives: Cross-country differences in chronic kidney disease (CKD) burden across Europe, as estimated by the Global Burden of Disease (GBD) study, are often interpreted as reflecting unequal diagnosis, yet this interpretation has rarely been examined against other data sources. This study examined associations between economic, social and environmental determinants and CKD prevalence and mortality across 29 European Union and European Economic Area countries, assessed convergence between 1990 and 2023, and compared GBD estimates with vital registration data. Materials and Methods: Age-standardized CKD prevalence, mortality and disability-adjusted life years were obtained from GBD 2023. Cross-sectional regression (2023; heteroskedasticity-consistent standard errors; n = 27), k-means cluster analysis, and sigma- and beta-convergence analyses were performed. GBD mortality was compared with Eurostat death rates for diseases of the kidney and ureter (ICD-10 N00–N29, 2011–2023). GBD input sources for CKD prevalence were reviewed for Estonia, Latvia, Lithuania and Austria. Results: No structural determinant was robustly associated with CKD prevalence or mortality, and outcomes did not differ significantly across the three-cluster typology (Kruskal–Wallis, p = 0.17–0.75). Mortality dispersion declined between the mid-1990s and the mid-2000s and stagnated thereafter. Prevalence dispersion increased marginally until the mid-2000s, with no significant trend from 2008 onward. Rank agreement between GBD and Eurostat mortality was moderate (ρ = 0.38 in 2023, down from 0.61 in 2017) and improved when diabetes deaths were added (ρ = 0.66). Estonia showed the largest discrepancy. Prevalence estimates for all four reviewed countries relied mainly on kidney replacement therapy registries, and no population-based source was identified for Latvia or Lithuania. Conclusions: The structural determinants examined did not explain cross-country differences in GBD-estimated CKD burden, and no consistent regional pattern emerged. Part of this variation is compatible with differences in cause-of-death coding and sparse local input data. GBD-derived estimates alone are therefore insufficient to infer diagnostic inequality between countries, and direct indicators of screening and detection are needed.