ESRD patients in 2004: global overview of patient numbers, treatment modalities and associated trends

Abstract

Since the beginning of maintenance therapy for end-stage renal disease (ESRD) through dialysis or transplantation, the number of patients treated for terminal kidney failure worldwide has continued to grow at a rate that is far in excess of the growth rate of the general population. By 2001, more than 1 million patients were reported worldwide to receive dialysis treatment alone, with the numbers growing at an annual global average rate of 7% [1,2]. The main factors contributing to the continued growth are the universal ageing of populations, multi-morbidity, higher life-expectancy of treated ESRD patients and increasing access of a generally younger patient population to treatment in countries in which access had previously been limited [3–6]. Solutions targeting the prevention or reversal of renal disease receive widespread attention, but have as yet failed to significantly change the development of global patient numbers. A superior and financially viable alternative to dialysis or allograft transplantation for chronic renal failure is not foreseen for the near or even mid-term future [6–9]. In order to facilitate effective future planning by healthcare authorities, reliable and up-to-date information on ESRD patient numbers, development trends, treatment modalities and treatment outcomes are indispensable. An increasing number of national and international renal registries have provided valuable demographic and epidemiologic information on renal patients since the first report of the European Dialysis and Transplant Association (EDTA) was published in 1965 [6,10–17]. These reports provide a base for comparison between specified patient populations and an understanding of treatment practices and policies and their implications for the well-being of those undergoing treatment for ESRD. The conclusions that can be drawn from such considerations provide knowledge of value to both medical communities and policy makers throughout the world. Even at a national level, data collection and analysis requires extensive resources to enable fast and reliable reporting of the most recent numbers. The collection of records reflecting the situation in a large group of countries presents additional challenges that render timely reporting a difficult target to achieve. A multi-country European database is organized by the ERA/EDTA, and now consolidates renal replacement information from different renal registries collecting patient data of 27 countries [16]. An alternative approach to reporting international ESRD-relevant data is pursued in the Dialysis Outcomes and Practice Patterns Study (DOPPS). This was initiated in 2002 as an observational study and presently collects information on haemodialysis (HD) practice patterns and their associated outcomes from 12 countries in Europe, North America and Asia [15]. Fresenius Medical Care, the largest dialysis care company worldwide, follows two different and separate approaches, one addressing practice patterns and outcomes in its clinics (e.g. the European Clinical Database, EuClid), and the other using its extensive international network for retrieving and comparing reliable and contemporary ESRD demographic information from 122 countries [2,18]. This article supplies an extract of the latter for use and reference by renal care specialists and healthcare administrative bodies. In addition, trends observed in association with patient demographic data are specified and discussed. Details pertaining to the treatment of patients with ESRD were collected for 122 countries that have established dialysis programmes and to which the Fresenius Medical Care international dialysis network has insight. The individual countries are listed in Table 1. With a combined population of 5.9 billion, these countries represent 92% of the total world population. For practical reasons, some widely accepted special administrative areas or regions of special sovereignty are also termed countries throughout this article. Countries included in the survey Countries included in the survey The country-by-country surveys performed at the end of each calendar year focus on the total number of patients treated for ESRD, the treatment modality selected, products used, treatment location and ESRD patient care structure and funding. The survey has been refined over the years to facilitate access to more detailed information and to reflect changes in the development of therapies and products. Its modular design allows the information from all countries to be consolidated and compiled in one central database. The questionnaires are prepared in English and, in some cases, the relevant local language, and are distributed to professionals in the field of dialysis who are in a position to insert ESRD-relevant country-specific information themselves or who can coordinate appropriate input from knowledgeable contacts in each country. Country demographic and economic data are extracted from publicly available and intern