International comparison of ESRF rates, and disparities in access to dialysis and transplantation
In a international study (Thurlow, 2021), the authors examined: geographic variation and global trends in ESRF incidence and prevalence; and variations in renal replacement therapy (RRT), practice patterns, and mortality.
Why is this important?
The global epidemiology of end-stage renal failure (ESRF) reflects each nation’s unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESRF – i.e. RRT = dialysis and kidney transplantation – depends on local disease burden, culture, and socioeconomics.
What did the study show?
From 2003 to 2016, the incidence (new cases) of treated ESRF were relatively stable in many higher income countries (HICs) but rose substantially predominantly in East and Southeast Asia.
The prevalence (all cases) of treated ESRF has increased worldwide, probably due to improving ESRF survival, population demographic shifts, higher prevalence of risk factors, and increasing RRT access in countries with growing economies.
Worldwide, there is a greater prevalence of RRT in HICs. Also the number of people who die prematurely because of lack of access to RRT is estimated at up to 3 times higher than the number who receive treatment.
For example, Taiwan, the USA, Mexico, and Thailand reported the highest incidences of treated ESRF (493, 378, 355, and 346 pmp/year, respectively).
Amongst HICs, ESRF incidence is the lowest in Nordic countries, other European countries, Australia, and New Zealand. These countries have universal health care systems (including RRT access); so the lower rates could be due to relatively low incidence, or delayed chronic kidney disease (CKD) progression.
The lowest treated ESRF incidences – ranging from 22 to 85 pmp/year – were reported by South Africa, Ukraine, Belarus, Bangladesh, Russia, Jordan, Peru, Colombia, Iran, Albania, and Estonia. Thus, in emerging and developing countries (EDCs), many people in need of RRT as a life-sustaining treatment do not receive it, where health care resources are severely limited.
Unadjusted 5-year survival of ESKD patients on RRT was 41% in the USA, 48% in Europe, and 60% in Japan. Dialysis is the predominant RRT in most countries, with haemodialysis being the most common modality.
How does this affect you?
You cannot choose the country where you live. But we all need to educate ourselves about the wide international variations in rates of ERSF and RRT; with a responsibility of HICs to support EDCs both in access to RRT, and treatment of CKD (to prevent ESRF).
Reviewed by Poppy Stein.
Last Reviewed on 26 June 2024
