Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy

作者：John S. Thurlow, Megha Joshi, Guofen Yan, Keith C. Norris, Lawrence Y C Agodoa, Christina M. Yuan, Robert J. Nee · 发表于：American Journal of Nephrology · 年份：2021 · DOI：10.1159/000514550 · 被引用次数：879 · 研究领域：Dialysis and Renal Disease Management、Chronic Kidney Disease and Diabetes、Renal Transplantation Outcomes and Treatments

BACKGROUND: The global epidemiology of end-stage kidney disease (ESKD) reflects each nation's unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESKD, particularly regarding kidney replacement therapy (KRT), depends on local disease burden, culture, and socioeconomics. Here, we explore geographic variation and global trends in ESKD incidence and prevalence and examine variations in KRT modality, practice patterns, and mortality. We conclude with a discussion on disparities in access to KRT and strategies to reduce ESKD global burden and to improve access to treatment in low- and middle-income countries (LMICs). SUMMARY: From 2003 to 2016, incidence rates of treated ESKD were relatively stable in many higher income countries but rose substantially predominantly in East and Southeast Asia. The prevalence of treated ESKD has increased worldwide, likely due to improving ESKD survival, population demographic shifts, higher prevalence of ESKD risk factors, and increasing KRT access in countries with growing economies. Unadjusted 5-year survival of ESKD patients on KRT was 41% in the USA, 48% in Europe, and 60% in Japan. Dialysis is the predominant KRT in most countries, with hemodialysis being the most common modality. Variations in dialysis practice patterns account for some of the differences in survival outcomes globally. Worldwide, there is a greater prevalence of KRT at higher income levels, and the number of people who die prematur...