End-stage renal disease: unmet treatment needs across the globe

Abstract Background Chronic kidney disease (CKD) is a major health and economic burden globally. This progressive disease is treatable by dialysis and kidney transplantation when the kidneys reach CKD stage 5 or end-stage renal disease (ESRD), but these two interventions are very expensive and often unavailable in low-resource settings. The aim of this study is to provide a country-level comparison of dialysis rates, transplantation rates, and untreated CKD stage 5 in order to identify countries and regions with large disparities and unmet treatment need for ESRD. Methods We used a negative binomial Bayesian meta-regression tool to analyse data collected from systematic literature reviews and national renal replacement registries in order to estimate incidence and prevalence of ESRD on dialysis, ESRD with kidney transplantation, and untreated ESRD for 187 countries by year, age, and sex. We then assessed ratios of treated to untreated ESRD to identify countries with extreme unmet need for kidney disease treatment. Findings Both dialysis and kidney transplantation rates have increased considerably since 1990, but there are still significant disparities both within and across countries. Globally in 2010, the proportion of CKD stage 5 and ESRD patients who received dialysis or had kidney transplantation was only 58·9% (95% CI 55·6–61·0), ranging from less than 2% in most of sub-Saharan Africa to over 70% in high-income North America, high-income Asia Pacific, and east Asia. Interpretation These estimates are a crucial factor to help to inform public health policy decisions and the nephrology community, especially in countries previously lacking such estimates. There is an urgent need for better monitoring and data collection of CKD stage 5 in order to better prepare health systems for ESRD treatment needs. Funding Bill & Melinda Gates Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.