Journal Information
Vol. 36. Issue. 4.July - August 2016
Pages 333-464
Vol. 36. Issue. 4.July - August 2016
Pages 333-464
Special article
DOI: 10.1016/j.nefroe.2016.10.001
Open Access
COSMOS Project: Haemodialysis scenario in Europe
Proyecto COSMOS: escenario de la hemodiálisis en Europa
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Jorge B. Cannata-Andía
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cannata@hca.es

Corresponding author.
, José Luis Fernández-Martín
Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación Nefrológica, REDinREN at the Instituto de Salud Carlos III. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo (Asturias), Spain
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Table 1. Site-specific form.
Table 2. Patient-specific form.
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The COSMOS project is an observational, prospective, open-cohort, multi-centre European study with 3 years of follow-up, designed, conducted and led by the Bone and Mineral Research Unit at Hospital Universitario Central de Asturias in Spain in collaboration with 227 dialysis centres (21 of them Spanish) in 20 countries in Europe. The main aim of the project is to study Mineral and bone disorders in patients with stage 5D chronic kidney disease. The study was conducted at medium- to large-sized dialysis centres (more than 40 patients/centre) and patients in haemodialysis over 18 years of age who had not previously received a transplant were included.

Dialysis centres in 20 participating countries were randomly selected from the census of European dialysis centres. The total number of patients selected per country was proportional to the number of patients in haemodialysis in that country; therefore, the most populated countries contributed with more patients to the study. Each country was stratified by geographic area and centres were selected randomly within each of these areas so that patients were representative of each country and the entire Europe. For example, Germany was divided into 4 areas (north, south, east and west), Italy and France were divided into 3 areas (north, centre and south), Spain was divided into 3 areas (north, south and east) and Poland was divided into 5 areas (north, south, east, west and centre). At each centre 20 patients were randomly selected.

Following this methodology, 4500 patients were initially randomly selected (baseline cohort). As the study had an open-cohort design, during the 3-year follow-up another 2.297 patients (replacement cohort) were included. These patients replaced those who left the study for whatever reason (death, transplant, transfer to another dialysis unit or any other cause). Therefore, in COSMOS, a total of 6797 patients were studied. This open-cohort design allowed the same number of patients to be maintained throughout the 3-year follow-up and allowed there to be 2 cohorts for study, the baseline cohort and the replacement cohort.

Each centre had to fill in a questionnaire with 15 questions about its routine clinical practice (Table 1, centre-specific questionnaire). In addition, it had to collect patient data including demographic data, comorbidities, treatments and Laboratory parameters (27 questions) (Table 2, patient-specific questionnaire). The same information was collected every 6 months for 3 years (monthly in the case of clinical-chemistry parameters and semi-annually in the case of the others), as well as events having occurred in the previous months (death, hospitalisations, fractures and other matters of interest).

Table 1.

Site-specific form.

Source: Taken from Fernandez-Martin et al.2
Table 2.

Patient-specific form.

 
 
Source: Taken from Fernandez-Martin et al.2

All data were collected by the investigators at each site in a specially designed web form. To minimise errors in data collection, the computer system warned the investigator when the values entered were not within a predetermined range that had been catalogued with reasonable lower and upper limits for that parameter.

The COSMOS study started in February 2005 and data collection ended in July 2010. The complete and detailed design of the study was published during the patient inclusion and data collection period.1 From July 2010 to December 2011 database structuring, homogenisation and purification were performed. Given the logistical complexity of the study, each of the 20 participating countries had a national coordinator who was a member of the study's International Committee.

Given the magnitude, multinational nature and complexity of COSMOS, the initial agreements signed between the principal investigator and director of the COSMOS project, and the sponsors and funders of the study (European Renal Association-European Dialysis Transplant Association [ERA-EDTA], Amgen, Fundación Renal Íñigo Álvarez de Toledo [FRIAT], Executive Scientific Committee and International Committee) expressly mentioned the safeguarding and use of the database, which were the responsibility of the manager and principal investigator of the COSMOS project. These agreements specified that the national coordinators could not access raw patient data, safeguarded in Oviedo by the principal investigator of the study, and to have access to data would require the presentation of specific proposal, based on the data collected in the COSMOS database (Tables 1 and 2). The proposal would be submitted to the project director, who would make a decision about its viability and interest after analysing it with the members of the Coordinating Site in Oviedo and with the Executive steering committee.

In the cases in which this proposal is considered to be viable and of interest, the Coordinating Site in Oviedo and the requester would agree upon the protocol of the study and the use of the database, which would always be organised and supervised by the Coordinating Site in Oviedo. Publications obtained from these actions would be prepared jointly by the head of the proposal and by the COSMOS Coordinating Site, who would jointly decide upon the authorship of the publication, following the criteria established in the initial COSMOS publication agreements.

Considering COSMOS to be a strategic project of the Spanish Nephrology Society (SEN) provides an opportunity for SEN members to present proposals following the same conditions established by the Executive steering committee and for the International steering committee mentioned above and to propose studies based on the data collected in COSMOS (see Tables 1 and 2), through a detailed research proposal that will be addressed to the manager and principal investigator of the COSMOS project.

To date, within the COSMOS project, 18 specific studies have been scheduled; 14 were proposed by the Coordinating Site in Oviedo and the other 4 were proposed by the Executive steering committee and the International steering committee. Of these analyses, five have been published,2–6 two were recently submitted for publication and are under review, seven are in progress with most analysis having been performed and the others are in the preparative stage. Once all scheduled studies are completed and published, in accordance with the agreement signed at the start of the project by the promoters and sponsors of the study, the database will be transferred from the Coordinating Site in Oviedo to the ERA-EDTA Registry.

Conflicts of interest

COSMOS has the sponsorship of the Bone and Mineral Metabolism Department at Hospital Universitario Central de Asturias, the Asturias Society for the Promotion of Bone Research (SAFIM), the European Renal Association-European Dialysis and Transplant Association, the 2008–2011 Spanish National R&D&I Programme and the Instituto de Salud Carlos III (ISCIII), the ISCIII-RETIC REDinREN (RD06/0016/1013 and RD12/0021/1023), the ISCIII (ICI14/00107), the European Regional Development Fund (ERDF), the 2013–2016 Spanish State R&D&I Plan, the 2013–2017 Asturias Science, Technology and Innovation Plan (GRUPIN14-028) and the Fundación Renal Íñigo Álvarez de Toledo (FRIAT). Logistics (meetings, secretary, printing of material, development of website for data collection, etc.) have been funded by Amgen Europe and the Fundación Renal Íñigo Álvarez de Toledo (FRIAT). The authors have no knowledge of any additional relationships or funding that may be perceived as a conflict of interest that may affect the objectivity of this study.

Annex
Current membership of the Committees of the COSMOS project

Principal investigator of COSMOS: Jorge B. Cannata-Andía.

Project manager: José Luis Fernández Martín.

Coordination and Statistical Analysis Team in Oviedo:

Jorge B. Cannata-Andía, José Luis Fernández Martín, Pablo Martínez Camblor, Manuel Naves Díaz, Adriana Dusso.

Executive steering committee:

Jorge B. Cannata-Andía, José Luis Fernández Martín, Carmine Zoccali, Gérard M. London, Francesco Locatelli, Markus Ketteler, Aníbal Ferreira, Adrian Covic, M. Dolores del Pino y Pino,* Rafael Santamaría Olmo,* Emilio Sanchez Álvarez.*

*Members of the Executive Scientific Committee during the period in which COSMOS is considered to be a research project linked to strategic studies of the SEN.

International steering committee:

Jürgen Floege, Markus Ketteler, Gérard M. London, Francesco Locatelli, José Luis Górriz, Boleslaw Rutkowski, Aníbal Ferreira, Dimitrios E. Memmos, Dierik Verbeelen, Christian Tielemans, Adrian Covic, Vladimir Teplan, Willem Jan Bos, Judit Nagy, Reinhard Kramar, David J.A. Goldsmith, Pierre-Yves Martin, Rudolf P. Wüthrich, Drasko Pavlovic, Mihael Benedik.

Participating sites:

Austria: Univ. Prof. Dr. Leo Marosi. A. Ö. Krankenhaus (Wiener Neustadt). Dr. Bernhard Robl. A. Ö. Krankenhaus D. Elisabethinen (Linz). Prim. Dr. Heinrich Kiss. A. Ö. Landeskrankenhaus Dialysestation (Oberwart). Prim. Dr. Ulrich Neyer. Abt. F. Nephrologie und Dialyse Lkh Feldkirch (Feldkirch). Prim. Dr. Wilfried Jilly. Dialyse-Institut Pörtschach (Klagenfurt). Prim. Dr. Kramar. Klinikum Kreuzschwestern Wels GmbH, 3. Interne Abteilung-Nephrologie (Wels Austria). Belgium: Prof. Dr. Dierik Verbeelen. A. Z. V. U. B. (Brussel). Dr. Anne Wauters. Az St. Lucas (Gent). Dr. René Cuvelier. C.M. de Mouscron (Mouscron). Prof. Max Dratwa. Chu Brugmann (Bruselas). Dr. Christian Tielemans. Clin. Universitairesde Bruxelles, Hospital Erasme (Bruselas). Dr. François Dehout. Hôpital Civil (Charleroi). Dr. Pierre Claus. Region. Zieke Nhuis St. Trudo (Sint-Truiden). Prof. A. M. Dhondt. Uz Gent (Gent). Croatia: Dr. Branka Jeren-Strujic. Dialysis Center KB Dubrava (Zagreb). Dr. Marijana Gulin. Dialysis Center OB Sibenik (Sibenik). Dr. Valentina Coric-Martinovic. Dialysis Center OBVinkovci, Zvonarska. Dr. Drasko Pavlovic. University Hospital Sestre Milosrdnice (Zagreb). Czech Republic: Dr. Jana Smr-zova. Brno-Bohunice, Dialyzacni Stredisko (Brno-Bohunice). Dr. Pavlikova. Dialyzacni Stredisko (Pardubice). Dr. Valkovsky. Faculty Hospital Ostrava, Department of Medicine (Listopadu). Dr. Zahradnik. Fakulti Nemocnice, Dialyzacni Stredisko (Hradec Kralove). Dr. Vladimir Teplan. Institute for Clinical and Experimental Medicine (Praga). Dr. Stranik. Nem. na Homolce (Praga). Dr. Pavukova. Nemocnice Poliklinikou, Dialyzacni Stre-disko (Chomutov). Dr. Moucka. Nemocnice (Kolin III). Denmark: Overlæge Kjeld Otte. Fredericia Sygehus, Dialysis Unit (Fredericia). Dr. James Heaf. Herlev Hospital. Overlæge Henning Danielsen. Viborg Sygehus, Dialysis Unit. Finland: Dr. MariKolunen. Päijat-Hämeen Keskussairaala/Dialyysi (Lahti). LL Markku Asola. Satakunnan Keskussai-Raala Dialyysi (Pori). France: Dr. Philit Jean-Baptiste. Centre allege d’hémodialyse, AURAL, Hotêl Dieu Chambery. Dr. Philippe Nicoud. Centre D??Hemodialyse de La Vallee Blanche (Chamonix). Dr. FrançoisLouis Maurice and Dr. Rouanet C. Centre D??Hemodialyse du Languedoc Mediterraneen (Montpellier, Cedex). Dr. Mohamed Brahim Bounab. Centre de Dialyse La Fonderie (Mulhouse). Dr. Philippe Bertocchio. Centre de Martigues (Martigues). Dr. Guillaume Jean. Centre du Rein Artificiel (Tassin la DemiLune). Dr. Bony Chantal. Centre ECHO. Dr. Daniel Toledano. Centre Henri Künstziger (París). Dr. Pierre Grimal. Centre Hos-pitalier Côte Basque. Dr. Jacques Gaultier. Centre Hospitalier Général (Gap Cedex). Dr. Alex Mouneimne. Centre Hospitalier Général (Montelimar). Dr. Brignon. Centre Hospitalier Louis Pasteur (Colmar Cedex Alsace). Dr. Dupuy. Centre Hospitalier, Service Hémodialyse Chiva (Pamiers). Dr. Jean-Paul Jaulin. Ch. Les Oudairies. La Rouche Sur Yon). Dr. Pablo Urena. Clinique de L??Orangerie (Aubervilliers). Dr. Marc Pocheville. Clinique Des Hauts de Seine (París). Dr. Zins. Clinique Édouard Rist (París). Dr. Valérie Masson. Clinique Mutualiste Malartic. Dr. Marc Uzan. Clinique Rhone-Durance (Avignon Cedex 2). Dr. Dominique Besnier. Hémodialyse-Nephrologie (Saint Nazaire). Prof Michel Labeeuw. Hémodialyse Néphrologie (Pierre Binite). Dr. Glowacki. Hôpital Calmette. Dr. Cattanéo. Hopital Croix Rouge Française, Bois Guillaume. Dr. Ducloux Didier. Hopital de Besanc¸on. Dr. Bouchouareb. Hôpital de La Conception (Marseille). Dr. Petitjean Philippe. Hopital Emi-lle Muller. Dr. Dahmane Djamel. Hopital Henri Mondor. Dr. Ang Kim-Seng. Hopital Saint-Brieuc. Dr. Saveanu. Hôpital Ste Marguerite, Néphrologie et Hémodialyse (Marseille Cedex 9). Dr. Gerard London. Hospital Manhes, (Francia). Dr. Bouali Boussad. Institut Mutualiste Montsouris (Cedex 14, París). Dr. François-Pascal Wambergue. La Clinique du Bois (Lille). Dr. J. F. de Fremont. Polyclinique Saint-Côme. Dr. Michel. Serv. D’Hémodialyse et Néphrologie. Dr. Patrick Giraud, Dr. Jean-Paul Eche and Dr. Bernard López. Service D??Hemodialyse et Nephrologie (Montauban Cedex). Dr. Catherine Delcroix. Service D??Hemolodialyse (Nantes Cedex). Dr. Duchet. Service Hémodialyse Chiva (Foix Cedex). Dr. Ghandour Majdalani. Service Néphrologie-Hémodialyse (Evreux Cedex). Dr. Guy. Unité D. Dr. Hadj. Unité Néphrologie; Hémodialyse Adulte (Clermont-Ferrand). Dr. Marie-Paule Guillodo. Z. A. Du Questel (Brest). Germany: Prof. Dr. Med. Jochen Selbach. Caritas-Krankenhaus Bad Mergentheim GmbH Abt. Innere Medizin/Nephrologie (Mergentheim). Prof. Dr. Med. Arnold Röckel und PD Dr. Med. Bernd Krumme. Deutsche Klinik für Diagnostik Dialysepraxis (Wiesbaden). Dr. Bolley. Dialyse Katharinenhospital (Stuttgart). Dr. M. Grieger und Dr. W. Hahn. Dialyse-Gemeinschaftspraxis (Mayen). Dipl-Med Michael Poley. Dialysegemeinschaftspraxis Dres. Francke und Poley (Seehausen/Altmark). Dr. M. Daschner. Dialysepraxis (Saarbrücken). Dr. B. Iwig. Dialysepraxis (Meinengen). Dr. Med. Susanne Arendt. Dialysepraxis Ansbach. Dipl. Med. Dieter Berger. Dialysepraxis Borna (Borna). Dr. Bernd Wölbert. Dialysepraxis Düren. Dr. Holzmann. Dialysepraxis Erkelenz. Dr. Med. Guenther Graf und Dr. Med. Carsten Brockmann. Dialysepraxis Graf/Brockmann (Bad Bevensen). Prof. Dr. Med. WolfgangBrech. Dialysepraxis und Internistische Gemeinschaftspraxis Friedrichshafen. Dr. Med. Alexander Mandelbaum. Dialysepraxis Wiesloch (Wiesloch-Frauenweiler). Dr. Med. Wolfang Lauerwald. Dialysepraxis (Gera). Dr. J. Bunia. Dialysepraxis (Iserlohn). Dr. Med. Ulrich Lammer und Dr. Med. Diep Thanh Au. Dialysepraxis (Oldenburg). Dr. Med. Carsten Kurth und Dr. Med. Schnierda. Dialyse-Trainingszentrum Waldshut. Dr. Stolz. Dialyse-Zentrum (Germany). Dr. J. Harlos, Dr. S. Berweck. Dialysezentrum (Schweinfurt). PD Dr. Med. Karl-August Brensing. Dialysezentrum Godesberg. PD Dr. Med. Karl-August Brensing. Dialysezentrum Godesberg (Bonn). Dr. Med. B. Kreft. Dialysezentrum Hildesheim (PHV). Dr. Med. Heinrich Jahnz, Dr. Med. Wolfgang Kohnle und Dr. Med. Wilfried Kamen. Dialysezentrum Hochsauerland (Meschede). Dr. Sodemann. Dialyse-Zentrum Lahr. Dr. Med. Peter Nach-tigall. Dialysezentrum Nürtingen. Dr. Jürgen Schäffer. Dialy-sezentrum Peine. Dr. Leimenstoll. Dialysezentrum PHV (Kiel). Dr. Med. Karl-Otmar Stenger. Dialysezentrum Sinstorf (Hamburgo). Dr. Wollschläger. Dialysezentrum Weyhausen. Dr. Med. Christine Langer. DTZ Dialyse-Trainings-Zentrum (Annaberg/Geyersdorf). Dr. Med. Wolfgang Clasen. Herz-Jesu-Krankenhaus Hiltrup Innere Medizin II/Nephrologie und Dialyse (Westfalenstr). Dr. Christoph Röger. Internist-Nephrologe-Hypertensiologe DHL Nierenklinik Rhein-Erft Gemeinschaftspraxis für Nieren- und Bluthochdruckkrankheiten Nephrologie Kerpen Leitender Arzt Dialysezentrum Kerpen. Dr. Klaus Burkhardt. KfH Kuratorium für Dialyse und Dr. Jutta Steinbach. KfH Kuratorium für Dialyse und Nierentransplantaion e. V. Prof. Dr. Med. Walter Schulz. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Bamberg). Prof. Dr. Med. Wolfgang Pommer. Dr. Baerhausen. KfHKuratorium für Dialyse und Nierentransplantation e. V. (Berlín). Dr. Med. Michael Wilfling und Dr. Med. Karla Schmaltz. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Bremen). Dr. Med. Michael Eichhorn. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Regensburg). Dr. Med. Bertil Oser und Dr. Med. Eckhard Müller. KfH Kuratorium für Dialyse und Nierentransplantation e. V. KfH Nierenzentrum Nierenzentrum im Cusanus Krankenhaus (Bernkastel-Kues). Dr. Med. Carola Striebing. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Dessau). Prof. Dr. Med. Hans-Paul Schobel. Dr. Wolfgang Ludwig. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Tutzing). Prof. Dr. Med. Ulrich Frei, Dr. Med. Helmut Peter Becker und Dr. Med. Hans-Christoph Fischer. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Berlín). Dr. Med. Maximilian Goller. KfH Kuratoriumfür Dialyse und Nierentransplantation e. V. (Deggendorf). Dr. Rer. Nat. Dieter Brückner und Dr. Med. Gottfried Janning. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Dortmund). Dr. Med. Wolfgang Bagnewski und Dr. Med. Horst Preßler. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Dülmen). Dr. Med. Christoph Haufe. KfH Kuratoriumfür Dialyse und Nierentransplantation e. V. (Erfurt). Prof. Dr. Med. Peter Grützmacher und Dr. Med. Hans-Joachim Miska. KfH Kuratorium für Dialyse und Nierentransplantation e.V. (Frankfurt). Prof. Dr. Med. Tomas Lenz. KfH Kuratoriumfür Dialyse und Nierentransplantation e. V. (Ludwigshafen). Dr. Med. Olaf Frank Hoeft. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Seelow). Dr. Med. Rolfdieter Krause. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Berlín). Prof. Dr. Kirsten de Groot. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Offenbach). Dr. Med. Helmut Armbruster, Dr. Med. Klaus Kalkreuth, Dr. Med. Peter Spellerberg, Dr. Med. Wolfgang Stützer. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Stolberg). Dr. Med. Josef Nikolay. KfH Kuratorium für Dialyse und Nierentransplantation e. V. (Fürth). Dr. Rüdiger Schmidt. KfH Nierenzentrum-Wesel. Prof. Dr. J. Mann. KfH-Zentrum (München Schwabing). Dr. Rainer Roth. Klaus. Burkhardt@kfhdialyse. de. Dr. Med. Johann-Borwin Lüth und Dr. Med. Sybille Merscher und Dr. Med. Hans-Jürgen Schmidt-Gürtler. Klinikf. Nieren- und Hochdruckkrankheiten Nephrologie-Dialyse (Hannover). Dr. Wolfgang Gross. Krankenhaus Bethanien. Dr. Dehnert und Dr. Roth. LC-Dialysezentrum (Dernbach). Prof. Jürgen Floege und Prof. Markus Ketteler. Medizinische Einrichtung der RWTH-Aachen (Aachen). Prof. Stefan Hei-denreich. Nephrolog. Gemeinschaftspraxis. Dr. Med. Günter Bahlmann. Nephrologische Gemeinschaftspraxis. Dr. Med. Olaf Loke. Nephrologische Gemeinschaftspraxis für Dialyse und Lipidapherese (Lüdenscheid). Dr. Med. Matthias Becker, Dr. Med. Rolf Ebbinghaus und Dr. Med. Matthias Weiß. Nephrologische Gemeinschaftspraxis (Bremen). Dr. Med. Berhard Frye, Dr. Med. Fritz Matzkies und Dr. Katrin Gebauer. Nephrologisches Gemeinschaftspraxis (Münster). Prof. Dr. Med. H.J. Schurek, Dr. Med. Markus Heck, Prof. Dr. Med. Helge Hohage, Dr. Med. Ullrich Welling, Dr. Med. Matthias Zeh. Nephrologisches Zentrum Emsland (Lingen). PD. Dr. Schwietzer. Nephrologisches Zentrum Weissensee. Prof. Dr. Hermann Haller. Neprhrologie/Dialyse (Hannover). Dr. Med. Jochen Selbach. Oberarzt Innere Medizin 3. Caritas-Krankenhaus. Dr. Med. Ulrike Metz-Kurschel. Onkologisch-Nephrologische Schwerpunktpraxis (Oberhausen). Dr. Med. Roland Fulde. Patientenheimversorgung. Dr. Med. Christoph Ganzemüller und Prof. Dr. Med. Jörg Radermacher. Patientenheimversorgung Minden (Minden). Dr. Med. Joachim Materna, Dr. Med. Oliver Hebgen und Dr. Med. Bernhard Weber. Patienten-Heimversorgung (Backnang). Dr. Med. Dieter Hummel. Patientenheimversorgung (Waiblingen). Dr. Scheuerle. St. Antonius-Hospital gGmbH (Kleve). Prof. Dr. Med. Horst Kierdorf. Städt. Klinikum Braunschweig (Braunschweig). Prof. Dr. Med. Horst Kierdorf. Städt. Klinikum Braunschweig Abteilung Nephrologie (Braunschweig). PD. Dr. Med. Joachim Beige. Städt. Klinikum St. Georg (Leipzig). Prof. Dr. Med. R. Lorenz. Head of Medical Clinic. Vogtland-Klinikum Plauen GmbH Nephrologie (Plauen). Dr. Med. Eckhardt Braasch. Werner Forssmann Krankenhaus (Eberswalde). Greece: Dr. Dimitrios Plakias. Athena Clinic. Dr. Liamos. General Hospital of Katerini. Dr. Stauroula Solomakou. General Hospital of Halkis. Dr. Georgios Bristogiannis. General Hospital of Kalamata. Dr. Kleonikos Kalaitzidis. General Hospital of Kavala. Dr. Dimitrios Kavvadias. General Hospital of Lamia. Dr. Dimitrios Memmos. Hippokratio General Hospital of Thessaloniki. Dr. Antonis Papantoniou. IASIS Clinic. Dr. Kyriaki Stamatelou. Kyanos Stavros. Dr. Ioannis Stefanidis. University Hospital of Larissa. Dr. Konstantinos Siamopoulos. University Hospital of Loannina. Hungary: Dr. Csaba Rikker. Dialysis Center Peterffy Sandor (Budapest). Dr. Imre Kulcsár. Eurocare Dialysis Center No 6 (Szombathely). Dr. Béla Tichy. Fresenius Dialysis Center (Kiskunfelegyhaza). Dr. Sandor Ferenczi. Petz Aladar County Hospital (Györ). Dr. Andrea Hering. ST. István Hospital (Budapest). Dr. Ottó Árkossy. St. Margit Hospital. Fresenius Dialysis Unit. (Budapest). Prof. Judit Nagy. Univ. Medical School (Pecs). Italy: Dr. Ascanio de Gregorio. Nephron-Ambulatorio Nefrologia Emodialisi S. R. Dr. Gianmaria Frattini. A. O. Ospedale Circolo e Fondazione Macchi. Dr. Antonio La Corte. Ambulatorio Nefrologia e Dialisi M. Malpighi. Dr. Ugo Rotolo. ARNAS-Ospedale Regionale Civico e Benfratelli. Divisione Nefrologia. Prof. Diego Brancaccio. Dr. Maurizio Gallieni. Dr. Fusaro. AZ. Ospedaliera S. Paolo Polo Universitario (Milán). Dr. Alberto Albertazzi. Azienda Ospedaliera Universitaria Policlinico di Modena. Dott. ssa. Livia Nazzaro. Casa di Cura S. Feliciano. Dr. Francesco Randazzo. Centro Dialisi Ippocrate. Prof. Francesco Locatelli. Department of Nephrology and Dialysis Ospedale A Manzoni (Lecco). Dr. Cosimo Lodeserto. Divisione Nefrol. e Dialisi (Taranto). Prof. Angela D’Angelo. Divisione Nefrol. e Dialisi (Trento). Prof. Giovanni Maria Frascà. Divisione Nefrologia (Padua). Dr. Fabio Malberti. Divisione Nefrologiae Dialisi (Cremona). Dott. Deni Aldo Procaccini. Divisione Nefrologia e Dialisi (Foggia). Dr. Cesare Dell. Divisione Nefrologia e Dialisi Ospedale A. Manzoni. Dott. Goffredo Del Rosso. Divisione Urologia. Servizio Nefrol. e Dialisi. Dott. ssa Spotti Donatella. Dr. Giuseppe Bianchi. Fondazione Centro San Raffaele del Monte Tabor Ospedale San Raffaele. Prof. Marco Biagini. Hospital S. Paolo. Hospital ASL RMF. Dr. Filippo Aucella/Dr. Antonio Scarlatella. Inst. Scient. di Ricovero e Cura Casa Sollievo. Prof. GP Segaloni Prof. A Jeantet. Molinette. Divisione Nefrol. e Dialisi. Dr. Marco Farina. Nefrologia e Dialisi Azienda Ospedaliera di Lodi. Dott. Canulla Francesco. Nomentana Hospital. Dott. ssa Maria Cossu. Osp. Regionale SS. Annunziata (Sassari). Dr. Ssa Gina Meneghel. Ospedale Civile-Servizio Nefrologia E Dialisi (Dolo). Prof. Mario Bonomini. Ospedale Clinicizzato SS. Annunziata-Chieti. Prof. Roberto Palla. Ospedale di Massa ASL 1-U. O. Nefrologia e Dialisi. Prof. Morosetti Massimo. Ospedale G. B. Grassi. Dr. Giancarlo Marinangeli. Ospedale Maria S. S. dello Splendore P. O. Giulianova. Dott. ssa Rosella Estivi. Ospedale Tolentino. Dott. Martin Giuliano. P. O. di Conegliano. Dr. Antonio Santoro Md. Poloclinico S. Orsola-Malpighi. Dott. Renzo Scanziani. Presidio Ospedaliero di Desio A. O. Vimercate. Dott. Conte Ferruccio. Servizi Nefrologia e Dialisi (Cernusco Sul Naviglio). Dr. Giorgio Munatetto. Dr. Pastori Giordano. Servizio Emodialisi, Ospedale di Chioggia. Dr. Giacomino Rossi. Servizio Nefrol. e Dialisi (Tolmezzo). Dr. Leonardo Cagnoli. Servizio Nefrologia e Dialisi (Rimini). Dr. Leonardo Cagnoli. Servizio Nefrologia e Dialisi (Rimini). Dr. Massimo Morossetti. Servizio Nefrologia e Dialisi (Roma Ostia Lido). Dr. D. Plutino. Servizio Nefrologia e Terapia Dialitica (Palmi). Dr. Alberto Galbiati. Sezione Nefrologia e Dialisi (Carbonia). Dr. Loreto Gesualdo. Struttura Complessa Nefrologia e Dialisi a Direzione Universitaria Ospedali Riuniti. Dr. Mario Querques. U. O. Nefrologia Ospedaliera Ospedali Riuniti. Dr. Giacomo Colussi. U. O. Nefrologia. A. O. Ospedale di Circolo e Fondazione Macchi. Dr. Adalberto Tommasi. Unita Operativa Nefrologia e Dialisi (Vimercate). The Netherlands: Dhr. Dr. E. F. H. van Bommel. Albert Schweizer Ziekenhuis (Dordrecht). Dr. Willem-Jan Bos. Antonius Hospital (Nieuwegein). Dhr. Dr. G. H. Verseput. Dialysis (Sittard). Dr. L. Vleming. Rode Kruis Ziekenhuis. Dhr. Dr. C. T. Op De Hoek. Sint Franciscus Gasthuis (Rotterdam). Dhr. Dr. H. W. van Hamersvelt. Universitair Medisch Centrum St. Radboud Geert Grooteplein (Nijmegen). Dr. F. Hoekstra. University Medical Center Groningen (Groningen). Mevr. Dr. H. A. H. Kaasjager. Ziekenhuis Rijnstate (Arnhem). Poland: Prof. Magdalena Durlik/Dr. Miroslav Grzeszczyk. Akad. Med. Instytut Transplantologii, Osrodek Dializ (Warszawa). Dr. Andrzej Rydzewski MD. Centr. Szp. Klin. Msw, Oddz. Dializoterapii (Warszawa). Dr. Dorota Sliwicka. Niepubliczny ZOZ, Stacja Dializ International Nephrology Centers Poland, (INCP) (Sochaczew). Dr. Janusz Ostrowski. Stacja Dializ Gambro (Wloclawek). Dr. Med. Antoni Sydor. Szp. Wojewodzki, I Oddz. Chor. Wewn i Nefrologii, z Osrodkiem Dializ (Tarnow). Dr. Tadeusz Gauda. Szpital ZOZ, Stacja Dializy, Pozaustrojowej (Glubczyce). Dr. Malgorzata Figarska. Szpital Powiatowy, Stacja Dializ. Dr. Slawomir Trudnowski. Szpital Specjalistyczny, Oddzia Dializ (Grudziadz). Dr. Med Justyna Matulewicz-Gilewicz. Szpital Wojew. Oddz. Nefrologiczny, ze Stacj Dializ (Suwalki). Dr. Marek Sobocki. Szpital Wojewódzki, Oddz. Nefrologiczny, ze Stacja Dializ (Belchatow). Dr. Jacek J. Felisiak. Szpital Wojewódzki, Oddz. Nefrologii, ze Stacj Dializ (Zielona Gora). Prof. Boleslaw Rutkowski. The Medical Academy (Gdansk). Dr. Med. Roman Rudka. Woj. Szp. Specj. Nr 4, Oddzia Nefrologiczny, Stacja Dializ (Bytom). Dr. Med. Kizysztof Bidas. Woj. Szp. Zesp. Oddz Nefrologii. Osrodek Dializ (Kielce). Dr. Pawel Krzywicki and Dr. Jaroslaw Hawryluk. Woj. Szpital Specj. Ooerodek Dializ (Chelm). Dr. Zdzislaw Gozdzik. Woj. Szp. Zesp. Oddzial Nefrologii, ze Stacja Dializ (Skierniewice). Dr. Krzysztof Dziewanowski. Wojew. Szp. Zesp. Oddzia Dializ XII D (Szczecin). Portugal: Dra. Cristina Resina. C. D. R. Clínica de Doenças Renais, Lda. (Lisboa). Dr. Fernando Carrera. Eurodial-Centro de Nefrologia e Diálise de Leiria, Lda. (Leiria). Dr. Pedro Afonso Coelho Maia. Fresenius Medical Care (Cancho) Cancho I (Coimbra). Dr. Joao Cruz. Fresenius Medical Care (Amadora), Nmc-Centro Médico Nacional, Lda. (Amadora). Dr. Aníbal Ferreira. Fresenius Medical Care. Hemodial-Centro de Diálise Renal, Lda. (Vila Franca de Xira). Dr. Ernesto Rocha. Fresenius Medical Care, Egidial-Centro de Hemodiálise da Guarda, Lda. (Guarda). Prof. Doutor Rui Alves. Fresenius Medical Care, Visodial-Centro de Diálise de Viseu, Lda. (Viseu). Dr. João Carlos Fernandes. Hospital de Santa Luzia (Viana do Castelo). Dr. Pedro Magalhaes Ponce. Hospital Garcia de Orta–Servic¸o de Nefrologia (Almada). Dr. Joao Paulo Travassos. Dra. Sílvia Ribeiro. Hospital Particular de Almada (Almada). Dr. Ilídio Rodrigues. Tagus Dial, Unidade de Tratamento de Doenças Renais, S. A. (Barreiro). Romania: Dr. Radu Macavei. Brasov County Hospital-Sarah Nephrology and Dialysis Center (Brasov). Prof Adrian Covic. C. I. Parhon Hospital Ia-Dialysis Center (Iasi). Dr. Cristian Gabriel Bako. Oradea County Hospital (Oradea). Dr. Radu Alecsandru. Prof. C. Tin Angelescu Hospital (Bucarest). Dr. Adrian Ghenu. Târgovite County Hospital. Hemodialysis Center (Targoviste). Dr. Ovidiu-Sorin Golea. Dr. Irinel Craciun. Timis County Hospital. Dialysis Center and Renal Transplantation (Timisoara). Dr. Ioana Iacob. Vrancea County Hospital. Hemodialysis Center (Vrancea). Slovenia: Dr. Simona Kralj-L opert. Interni oddelek dializa (Murska Sobota). Prof. Dr. Marko Malovrh. Klinieni Center Ljubljana (Ljubljana). Dr. Mihael Benedik. University Medical Centre (Ljubljana). Espa??na: Dra. Milagros Ortiz. Centro de Diálisis El Arroyo (Fuenlabrada). Dra. Ester Rubio et al. Centro de Diálisis Los Llanos (Móstoles/Madrid). Dr. Ramón Rentero. Centro de Diáalisis Alcer (Madrid). Dr. Soler Amigo. Centro Hospitalario Utat. Coronaria (Manresa). Dr. Enrique Ajenjo Mas. Centro Médico Jesus-Pechrol S. A. (Valencia). Dr. Josep Prim Gutiérrez. Clínica Gerona S. A. (Gerona). Dra. Guillermina Fernández Herrero. Clínica Santa Isabel (Sevilla). M. Josefa de la Torre Diz. Diagal, S. L. (Villagarcía de Arosa). Dr. Rafael Giner Seguí. Hemogan S. L. (Gandía). Dr. Juan Navarro González. Hosp. Nuestra Sra. de La Candelaria (Sta. Cruz de Tenerife). Dra. Megido. Hospital de la Cruz Roja (Gijón). Dr. Carlos Santiago Guervas. Hospital General de Alicante S. V. S. (Alicante). Dra. Carmina Gómez Roldán. Hospital General (Albacete). Dr. Fernando Vidaur Otegui. Hospital Ntra. Sra. Aránzazu. Servicio de Nefrología (San Sebastián). Dr. Guillermo Martín Reyes. Hospital Regional (Málaga). Dr. Antonio de Paula de Pedro. Hospital Río Ortega (Valladolid). Dra. Pilar Sánchez Pérez. Hospital San Francisco de Borja Servei Valenciano (Gandía). Dra. Margarita López. Hospital Santa Teresa (La Coru??na). Dra. M. Carmen Prados Soler. Hospital Torrecárdenas (Almería). Dr. José Luis Gorriz. Hospital Universitario Dr. Peset. Dra. María Dolores Paz Calvo. Dr. Rafael Romero Burgos. Inst. 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Birch Hill Hospital (Yorkshire). Dr. David Goldsmith. Dr. John Scoble. Guys Hospital (Londres). Dr. Thomas Mark. Heartlands Hospital. Dr. Martin Wilkie. Northern General Hospital. Dr. Mike Cassidy. Nottingham City Hospital. Dr. Morwenna Wood. Queen Margaret Hospital. Dr. Ramesh Naik. Royal Berkshire Hospital (Londres). Dr. Patrick Harnett. Southend Hospital. Dr. Stanley FAN. St. Bartholomew. Dr. Es Will and Dr. Charles Newstead. St James’ University Hosp.

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Pease cite this article as: Cannata-Andía JB, Martín JLF. Proyecto COSMOS: escenario de la hemodiálisis en Europa. Nefrología. 2016;36:381–388.

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