2009 USRDS Annual Data Report
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Twelve - International comparisons

We are pleased this year to present data from more than 40 regions and countries, again offering a worldwide picture of ESRD and the ways in which practitioners choose to treat it. This year we update our figures comparing the incidence and prevalence of ESRD around the world. Taiwan (whose data include only dialysis patients), Jalisco (Mexico), and the United States again report the highest rates of incident ESRD, at 415, 372, and 361 per million population, respectively. The Philippines, Finland, Romania, Iceland, and Iran, in contrast, report rates of 66–92, while reported rates are lowest in Bangladesh, Russia, and Pakistan, at 13, 28, and 29 per million population, respectively. Diabetes as a primary cause of ESRD accounts for a large proportion of incident ESRD patients. Malaysia, for example, reports a 2007 incident rate of 143 per million population, and nearly 59 percent of these patients have diabetes as their primary cause of renal failure. New Zealand, Israel, Taiwan, Japan, the United States, the Republic of Korea, and Hong Kong all report rates of ESRD due to diabetes exceeding 40 percent. Prevalent rates for 2007 were highest in Taiwan and Japan (dialysis only), at 2,288 and 2,060 per million population, respectively, followed by the United States and Germany, at 1,698, and 1,114. And reported rates for Jalisco have more than doubled in a span of five years, increasing from 394 in 2003 to 986 per million in 2007, with a 6.2 percent increase from 2006. Hemodialysis is the most common mode of dialysis therapy worldwide, evidenced by data showing that, in nearly 75 percent of reporting countries, at least 80 percent of patients are on this mode of therapy. This is not the case, however, in countries such as Hong Kong and Jalisco, where peritoneal dialysis is provided to 80 and 66 percent of patients, respectively. And home hemodialysis therapy is provided to nearly 10 percent of patients in Australia and 16 percent of patients in New Zealand. Renal transplant rates are many times a reflection not only of a country’s healthcare system, but of cultural diversities as well. Transplant rates are less than 10 per million population in countries such as Hong Kong, Bosnia and Herzegovina, Thailand, Malaysia, Russia, Romania, and Bangladesh, in contrast to rates exceeding 50 per million in the Netherlands, Norway, the United States, and Jalisco. Rates of functioning grafts reach 551 and 526 per million, respectively, in Norway and the United States, but are less than 30 per million in Russia, Romania, and Bangladesh. We invite all renal registries to send their data to the USRDS, using the form provided on page 399. You may return it to us by email or fax, at usrds@usrds.org, and 1.612.347.5878. We wish to thank all participating registries for their willingness to provide data on their ESRD programs and help us give a perspective on patients with ESRD worldwide.

Data presented only for those countries from which relevant information was available; “.” signifies data not reported. All rates are unadjusted. ^UK: England, Wales, & Northern Ireland (Scotland data reported separately). Data from Argentina, Czech Republic, Israel, Japan, Luxembourg, Shanghai, & Taiwan are dialysis only. *Latest data for Canada, Germany, Iran, Luxembourg, Pakistan, Russia, & Shanghai are for 2006. Data for France include 13 regions in 2005, 15 regions in 2006, & 18 regions in 2007.

Figure 12.1; see page 382 for analytical methods. All rates are unadjusted. Data from Japan & Taiwan are dialysis only.

Figure 12.2; see page 382 for analytical methods. Data presented only for those countries from which relevant information was available. All rates are unadjusted. Data from Argentina, Czech Republic, Israel, Japan, Luxembourg, Shanghai, & Taiwan are dialysis only. Latest data for Canada, Germany, Iran, Luxembourg, Pakistan, Russia, & Shanghai are for 2006. Data for France include 18 regions in 2007.

Incident rates of reported ESRD in 2007 were greatest in Taiwan (dialysis only), at 415 per million population, followed by Jalisco (Mexico), the United States, Japan (dialysis only), and Turkey, at 372, 361, 285, and 229, respectively. Rates of less than 100 per million were reported by Bangladesh, Iceland, Romania, Finland, and the Philippines. As stated in previous ADRs, it is important to note the distinction between the incidence of treatment, guided by available funding, and the incidence of the disease itself. An affluent nation may allow elderly patients and those with diabetes to receive hemodialysis, for example, while developing nations may restrict this treatment to younger, healthier patients. Figure 12.3 & Table 12.a; see page 382 for analytical methods.

Diabetes was the primary cause of ESRD in 58.5 percent of new patients in Malaysia in 2007, and 55 percent of those in Jalisco (Mexico). In Hong Kong, the Republic of Korea, the United States, Japan, Taiwan, Isreal, and New Zealand, 41–45 percent of new patients have this primary diagnosis. Countries reporting rates of ESRD due to diabetes of less than 20 percent include Romania, Iceland, Norway, Scotland, the Netherlands, the UK, and Bosnia and Herzegovina. Figure 12.4 & Table 12.b; see page 382 for analytical methods.

Taiwan and Japan (dialysis only) continue to report the greatest prevalent rates of ESRD, at, 2,288 and 2,060 per million population, respectively, in 2007. The next highest rate was reported by the United States, at 1,698. The lowest rates, of 74 and 99 per million, were reported by the Philippines and Bangladesh. Figure 12.5 & Table 12.c; see page 382 for analytical methods.

In Hong Kong, four of five prevalent dialysis patients were treated with CAPD/CCPD in 2007. This therapy was also widely used in Jalisco (Mexico) and New Zealand, at 65.8 and 35.9 percent, respectively. Hemodialysis remains the preferred mode of therapy worldwide; in New Zealand and Australia, however, 15.5 and 9.8 percent of patients, respectively, use home hemodialysis. Figure 12.6 & Table 12.d; see page 382 for analytical methods.

Reported prevalent rates of functioning grafts are greatest in Norway and the United States, at 551 and 526 per million population in 2007. Other countries and regions reporting rates above 400 per million include Canada, Hong Kong, Luxembourg, Belgium (both Dutch- and French-speaking), Finland, the Netherlands, Spain, Austria, France, and Sweden. Bosnia and Herzegovina, Russia, and Romania reported rates of 32, 29, and 22 per million. Figure 12.7 & Table 12.e; see page 382 for analytical methods.

Jalisco (Mexico), the United States, Norway, and the Netherlands reported transplant rates of 59.3, 58.1, 55.2, and 50.7 per million population in 2007. The reported rate was less than 10 per million, in contrast, in Hong Kong, Bosnia and Herzegovina, Thailand, Malaysia, Russia, Romania, and Bangladesh. Figure 12.8 & Table 12.f; see page 382 for analytical methods.