Date of Award

Spring 2023

Degree Type



Chemistry and Biochemistry

Director of Thesis

Teri Browne, Ph.D., MSW, NSW-C

First Reader

Mohammed Alzubaidi, MD, MBA, FASN, FNKF

Second Reader

Mohammed Alzubaidi, MD, MBA, FASN, FNKF


European nations and the United States of America have vastly different outcomes in their treatment of end-stage renal disease (ESRD) patients, specifically when considering survival rate and patient satisfaction level. Unfortunately, no study has ever detailed the reasons why this is the case. This thesis explores and compares the methods by which the United States and European nations treat chronic kidney disease (CKD) and ESRD patients. A literature review aimed to determine factors contributing to the varying outcomes between the two nations, and a Healthcare Provider Survey was crafted and administered to United States healthcare providers in order to determine their attitudes towards the US method of treating CKD and ESRD patients. This survey was also analyzed and compared to the healthcare literature to determine what healthcare providers believe about the healthcare system versus what the literature supports. Overall, this project concluded that myriad factors play into the varying levels of outcome for European and American CKD and ESRD patients. Some of these factors include variations in vascular access practices, time spent on dialysis, type of dialysis, number of transplants performed, diet, lifestyle habits, medications, age of population, prevalence of co-morbid diseases, nonadherence rates, satisfaction with ESRD care, and time spent with a provider during each visit. With the enumeration of contributing factors previously identified, further research should focus on distinguishing the best practices of American and European ESRD care.

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© 2023, Robert W Pokora III