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Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy
Open accessAbstract
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 prematurely because of lack of KRT access is estimated at up to 3 times higher than the number who receive treatment. Key Messages: Many people worldwide in need of KRT as a life-sustaining treatment do not receive it, mostly in LMICs where health care resources are severely limited. This large treatment gap demands a focus on population-based prevention strategies and development of affordable and cost-effective KRT. Achieving global equity in KRT access will require concerted efforts in advocating effective public policy, health care delivery, workforce capacity, education, research, and support from the government, private sector, nongovernmental, and professional organizations.
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“Diabetes is associated with a high rate of cardiovascular events and is also the leading cause of end-stage renal disease in the Western world (452).”
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“Diabetes is associated with a high rate of cardiovascular events and is also the leading cause of end-stage renal disease in the Western world (452).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [452]
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Metadata
- Authors
- Thurlow, J. S., Joshi, M., Yan, G., Norris, K. C., Agodoa, L. Y., Yuan, C. M., & Nee, R.
- Affiliations
- Uniformed Services University of the Health Sciences (US)
- University of Virginia (US)
- University of California, Los Angeles (US)
- National Institutes of Health (US)
- Venue
- American Journal of Nephrology
- Publisher
- S. Karger AG
- Published
- 2021
- Volume
- 52
- Issue
- 2
- Pages
- 98-107
- ISSN
- 0250-8095 (ISSN-L)
- 1421-9670
- PMC
- PMC8057343
- OpenAlex
- W3139528122
- Semantic Scholar
- 05b07bab0110bf2b0dbec0353ad07b1b281fbf70
- Cited by
- 855
- References
- 84
- Citations by year
- 2026: 141 · 2025: 207 · 2024: 214 · 2023: 170 · 2022: 104 · 2021: 17
- FWCI
- 20.74
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Nephrology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (Z99 DK999999, UL1TR000124, UL1TR001881)
- National Institute on Aging (P30AG021684)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK112008)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Keywords
- end-stage renal disease, renal replacement therapy, dialysis, hemodialysis, regional variation, incidence and prevalence, survival, treatment gap, health care access, low- and middle-income countries, health disparities, global equity, health policy
- MeSH terms
- Africa, Arteriovenous Shunt, Surgical, China, Developing Countries, Renal Dialysis, Humans, India, Kidney Failure, Chronic, United States, Global Health, Incidence, Prevalence, Survival Rate, Renal Replacement Therapy, Developed Countries, Healthcare Disparities
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