Dieter Haffner ^1* Jochen Ehrich ¹ Velibor Tasic ² Vidar O Edvardsson ^3,4 EVGENIA PREKA ⁵ Larisa Prikhodina ⁶ Constantinos J Stefanidis ⁷ Rezan Topaloglu ⁸ Diamant Shtiza ⁹ Ashot Sarkissian ¹⁰ Thomas Mueller- Sacherer ¹¹ Rena Fataliyeva ¹² Ina Kazyra ¹³ Elena Levtchenko ¹⁴ Danka Pokrajac ¹⁵ Dimitar Roussinov ¹⁶ Danko Milosevic ¹⁷ Avraam Elia ¹⁸ Tomas Seeman ¹⁹ Mia Faerch ²⁰ Inga Vainumae ²¹ Jannejanne.kataja@tyks.fi Kataja ²² Michel Tsimaratos ²³ Irakli Rtskhiladze ²⁴ Peter Hoyer ²⁵ György Reusz ²⁶ Atif Awan ²⁷ Danny Lotan ²⁸ Licia Peruzzi ²⁹ Nazym Nigmatullina ³⁰ Nasira Beishebaeva ³¹ Edite Jeruma ³² AUGUSTINA JANKAUSKIENE ³³ Olivier Niel ³⁴ Valerie Said-Conti ³⁵ Angela Ciuntu ³⁶ Snežana Pavićević ³⁷ Michiel J.S. Oosterveld ³⁸ Anna Bjerre ³⁹ Marcin Tkaczyk ⁴⁰ Ana Teixeira ⁴¹ ADRIAN CATALIN LUNGU ⁴² Alexey Tsygin ⁴³ Vesna D Stojanović ⁴⁴ Ludmila Podracka ⁴⁵ Tanja Kersnik Levart ⁴⁶ Mar Espino-Hernández ⁴⁷ Giuseppina Sparta ⁴⁸ Harika Alpay ⁴⁹ Dmytro D Ivanov ⁵⁰ Jan Dudley ⁵¹ Komiljon Khamzaev ⁵²

• ¹ Hannover Medical School, Hanover, Germany
• ² Faculty of Medicine, Saints Cyril and Methodius University of Skopje, Skopje, Skopje, North Macedonia
• ³ Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
• ⁴ Reykjavík University, Reykjavik, Iceland
• ⁵ Southampton Clinical Trials Unit, University of Southampton, Southampton, England, United Kingdom
• ⁶ Moscow State Institute of International Relations, Moscow, Moscow Oblast, Russia
• ⁷ Athens State University, Athens, West Virginia, United States
• ⁸ Ankara University, Ankara, Ankara, Türkiye
• ⁹ University of Medicine, Tirana, Tirana, Tirana, Albania
• ¹⁰ Haybusak University of Yerevan, Yerevan, Armenia
• ¹¹ Vienna School of Evidence Based Medicine Vienna, Vienna, Austria
• ¹² Baku State University, Baku, Azerbaijan
• ¹³ 1st Minsk City Clinical Hospital, Minsk, City of Minsk, Belarus
• ¹⁴ University Hospitals Leuven, Leuven, Brussels, Belgium
• ¹⁵ Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Federation of Bosnia and Herzegovina, Bosnia and Herzegovina
• ¹⁶ Sofia University, Sofia, Sofia City, Bulgaria
• ¹⁷ University of Zagreb, Zagreb, Croatia
• ¹⁸ The Cyprus Institute, Nicosia, Nicosia, Cyprus
• ¹⁹ Metropolitan University Prague, Prague, Prague, Czechia
• ²⁰ Aarhus University, Aarhus, Central Denmark Region, Denmark
• ²¹ Tartu University Hospital, Tartu, Tartu County, Estonia
• ²² Turku University Hospital, Turku, Finland
• ²³ Université Paul Cézanne Aix-Marseille III, Marseille, Provence-Alpes-Côte d'Azur, France
• ²⁴ Tbilisi State University, Tbilisi, Georgia
• ²⁵ Essen University Hospital, Essen, North Rhine-Westphalia, Germany
• ²⁶ Andrássy University Budapest, Budapest, Hungary
• ²⁷ University College Dublin, Dublin, County Dublin, Ireland
• ²⁸ Tel Aviv University, Tel Aviv, Tel Aviv, Israel
• ²⁹ Ospedale Sant'anna Di Torino, Turin, Piedmont, Italy
• ³⁰ Almaty Oncology Centre, Almaty, Kazakhstan
• ³¹ International School of Medicine Kyrgyzstan, Bishkek, Kyrgyzstan
• ³² Riga East University hospital, Riga, Latvia
• ³³ Vilnius University, Vilnius, Vilnius, Lithuania
• ³⁴ University of Luxembourg, Luxembourg, Luxembourg
• ³⁵ University of Malta, Msida, Malta
• ³⁶ Nicolae Testemiţanu State University of Medicine and Pharmacy, Chișinău, Moldova
• ³⁷ University of Montenegro, Podgorica, Montenegro
• ³⁸ VU Amsterdam, Amsterdam, Netherlands, Netherlands
• ³⁹ University of Oslo, Oslo, Oslo, Norway
• ⁴⁰ Medical University of Lodz, Łódź, Łódź, Poland
• ⁴¹ University of Porto, Porto, Portugal
• ⁴² University of Bucharest, Bucharest, Bucharest, Romania
• ⁴³ Moscow University Touro, Moscow, Moscow Oblast, Russia
• ⁴⁴ University of Novi Sad, Novi Sad, Vojvodina, Serbia
• ⁴⁵ Children's University Hospital Bratislava, Bratislava, Slovakia
• ⁴⁶ Pediatrična Klinika, Univerzitetnega Kliničnega Centra Ljubljana, Ljubljana, Slovenia
• ⁴⁷ HM Madrid Hospital, Madrid, Madrid, Spain
• ⁴⁸ University Hospital Zürich, Zurich, Zürich, Switzerland
• ⁴⁹ Istanbul University, Istanbul, Türkiye
• ⁵⁰ Kyiv Academic University, Kyiv, Ukraine
• ⁵¹ Bristol Heart Institute, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, England, United Kingdom
• ⁵² Amity University Tashkent, Tashkent, Uzbekistan

Background: There is a lack of information on the current healthcare systems for children with kidney diseases across Europe. The aim of this study was to explore the different national approaches to the organization and delivery of pediatric nephrology services within Europe.In 2020, the European society for Paediatric Nephrology (ESPN) conducted a crosssectional survey to identify the existing pediatric nephrology healthcare systems in 48 European countries covering a population of more than 200 million children.The reported three most important priorities in the care of children with kidney diseases were better training of staff, more incentives for physicians to reduce staff shortages, and more hospital beds. Positive achievements in the field of pediatric nephrology included the establishment of new specialized pediatric nephrology centers, facilities for pediatric dialysis and transplant units in 18, 16, and 12 countries, respectively. The most common problems included no access to any type of dialysis ( 12), inadequate transplant programs for all ages of children ( 12), lack of well-trained physicians and dialysis nurses (12), inadequate reimbursement of hospitals for expensive therapies (10), and lack of multidisciplinary care by psychologists, dieticians, physiotherapists, social workers and vocational counsellors (6). Twenty-five of 48 countries (52%) expected to have a shortage of pediatric nephrologists in the year 2025, 63% of clinical nurses and 56% of dialysis nurses. All three groups of health care professionals were expected to be lacking in 38% of countries. Prenatal assessment and postnatal management of renal malformations by a multidisciplinary team including obstetricians, geneticists, pediatricians, and pediatric surgeons was available in one third of countries.Our study shows that there are still very marked differences in pediatric health care systems across the European countries and highlights the need need for appropriate services for children with kidney disease in all European countries.