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The burden of chronic kidney disease (CKD) is driven by mortality and the necessity of kidney replacement therapy (KRT). CKD causes one death every 20 seconds globally and is among the fastest growing causes of death. It is forecast to become the 5th global cause of death and the 3rd in Western Europe by 2050. It is estimated that 511 549 European Union (EU) inhabitants depend on KRT, with nearly two thirds (≈310 000) treated by dialysis, and the remainder being kidney transplant recipients (≈200 000). KRT is provided by every EU country. France (96 317), Germany (77 900), Spain (67 604) and Italy (62 523) account for 60% of people on KRT in the EU. Prevalence per million population ranged from 560 (Luxembourg) to 2022 (Portugal). Germany (55 129) leads in the number of people on dialysis, followed by France (52 817), Italy (44 382) and Spain (29 879). In addition to differences in the relative number of dialysis and transplant patients, there were also EU-wide differences in modality of dialysis. The hemodialysis/peritoneal dialysis prevalence ratio ranged from 52.0 (Slovakia) to 3.4 (Sweden). The EU should be aware of the burden of KRT when designing regulations, such as the Accelerating Clinical Trials in the EU (ACT EU) and the EU Medical Device Regulation (MDR) or making decisions regarding the prioritization of diseases and the budget for research and healthcare.