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  Figure 12.1 Comparison of unadjusted ESRD incidence & prevalence worldwide
  Figure 12.2 Geographic variations in the incidence of ESRD (per million population), 2010
  Figure 12.3 Incidence of ESRD, 2010
  Figure 12.4 Percentage of incident patients with ESRD due to diabetes, 2010
  Figure 12.5 Incident rates of ESRD due to diabetes, by age, 2010
  Figure 12.6 Prevalence of ESRD, 2010
  Figure 12.7 Percent distribution of prevalent dialysis patients, by modality, 2010
  Figure 12.8 Prevalent rates of functioning grafts, 2010
  Figure 12.9 Transplant rates, 2010
  Table 12.a Incidence of ESRD, by year (per million population)
  Table 12.b Prevalence of ESRD, by year (per million population)
  Table 12.c Percent distribution of prevalent dialysis patients, by modality & year
  Table 12.d Prevalent rates of functioning grafts, by year (per million population)
  Table 12.e Transplant rates, by year (per million population)
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Chapter 12

International comparisons

Introduction

This international chapter has expanded each year as more countries participate in the collaborative effort to collate data for the public health surveillance of end-stage renal disease. This year, we report data from 41 regions and countries which have graciously sent data to the USRDS. Such information not only allows for international comparisons, but provides a context for data on the multiple ethnic and racial groups which constitute the diverse population of the U.S. The USRDS is well aware of the considerable challenges each country faces in gathering its data, and sincerely thanks the registries and providers for their efforts.

Reported rates of incident ESRD across the globe show important trends; rates have slowed in some countries, while rising or remaining stable in others. The U.S., Taiwan, and Japan continue to have some of the highest rates, at 369, 361, and 288 per million population in 2010. In Mexico, rates in Morelos (2009) and Jalisco reached 597 and 425, respectively.

In Taiwan, the prevalence of ESRD reached 2,584 per million in 2010, while rates of 2,260 and 1,870 were reported in Japan and the U.S.

More than one in two new ESRD patients in Jalisco (Mexico), Singapore, Malaysia, Morelos (Mexico), and New Zealand are reported to have diabetes. In Taiwan, Malaysia, and the United States, rates of diabetes in patients age 65–74 were 771, 767, and 609 per million population in 2010, and rates for U.S. patients age 75 or older were 543 per million.

Hemodialysis continues to be the most common mode of therapy worldwide, evidenced by data showing that, in over 70 percent of reporting countries, at least 80 percent of patients are on this mode of therapy. In Hong Kong, Mexico (Morelos, and Jalisco), in contrast, peritoneal dialysis is used by 76, 58, and 51 percent of patients, respectively. And home dialysis therapy is provided to 17.7 and 9.1 percent of patients in New Zealand and Australia.

Renal transplant rates are many times a reflection not only of a country’s healthcare system, but of cultural diversities and beliefs. As an example, transplant rates are less than 10 per million population in countries such as Malaysia, Russia, Romania, Bosnia/Herzegovina, Thailand, and Bangladesh, in contrast to rates above 60 in Jalisco (Mexico) and above 50 in the United States, Portugal, Norway, the UK, and the Netherlands. Rates of functioning grafts reach 608 and 580 per million population in Norway and the U.S., but are less than 50 in Boznia/ Herzegovina, Russia, Romania, and Morelos (Mexico).

We invite all renal registries to participate in our international data collection, and wish to thank all currently participating registries for their willingness to provide data on their ESRD programs, giving us a worldwide perspective on patients with ESRD. All rates unadjusted. Data from Argentina (2005–2007), Japan, & Taiwan are dialysis only. *Downturn in incident rates is due to changes in criteria for incidence & to changes in the payment system.

Figure 12.1 Comparison of unadjusted ESRD incidence & prevalence worldwide

Figure 12.2 Geographic variations in the incidence of ESRD (per million population), 2010 (see page 447 for analytical methods)

Data presented only for countries from which relevant information was available. All rates unadjusted. Latest data for Singapore & Morelos (Mexico), are for 2009. Data for France include 23 regions. Data for Belgium & for England/Wales/Northern Ireland do not include patients younger than 18.

Incidence of ESRD

Figure 12.3 Incidence of ESRD, 2010

Table 12.a Incidence of ESRD, by year (per million population)

Incident rates of reported ESRD in 2009 were 597 per million population in Morelos (Mexico), followed by 2010 reportings from Jalisco (Mexico), the United States, Taiwan, and Japan at 425, 369, 3361 and 288, respectively. Rates of less than 100 per million were reported in Scotland, Finland, Russia, & Bangladesh. 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 treatment to younger, healthier patients. Data presented only for countries from which relevant information was available; “.” signifies data not reported. All rates unadjusted. ^UK: England, Wales, & Northern Ireland (Scotland data reported separately). Data for Belgium & England/Wales/Northern Ireland do not include patients younger than 18. *Latest data for Singapore & Morelos (Mexico) are for 2009. Data for France include 13 regions in 2005, 15 regions in 2006, 18 regions in 2007, 20 regions in 2008 & 2009, & 23 regions in 2010.

ESRD due to diabetes

Figure 12.4 Percentage of incident patients with ESRD due to diabetes, 2010

Figure 12.5 Incident rates of ESRD due to diabetes, by age, 2010

In 2009 and 2010, diabetes was the primary cause of ESRD in 51–63 percent of new patients in Jalisco (Mexico), Singapore, Malaysia, Morelos (Mexico), and New Zealand. Hong Kong, Taiwan, the Republic of Korea, Israel, the United States, Japan, and Colombia all reported rates of ESRD incidence due to diabetes of greater than 40 percent. Countries reporting rates below 20 percent included Norway, Russia, Iceland, Romania, and the Netherlands.Incident rates of ESRD due to diabetes rise with increasing age. In 2009, Morelos (Mexico) reported a rate of 1,786 in those age 65–74, more than two time higher than the rates of 771, 767, and 609 reported by Taiwan, Malaysia, and the United States in 2010. Rates in the United States were 44, 367, and 543, respectively, for those age 20–44, 45–64, and 75 and older.Data presented only for countries from which relevant information was available. All rates unadjusted. ^UK: England, Wales, & Northern Ireland (Scotland data reported separately). Data for Belgium & England/Wales/Northern Ireland do not include patients younger than 18. *Latest data for Singapore & Morelos (Mexico) are for 2009. Data for France include 13 regions in 2005, 15 regions in 2006, 18 regions in 2007, 20 regions in 2008 & 2009, & 23 regions in 2010.

Prevalence of end-stage renal disease

Figure 12.6 Prevalence of ESRD, 2010

Table 12.b Prevalence of ESRD, by year (per million population)

Taiwan and Japan continued to report the highest rates of prevalent ESRD, at 2,584 and 2,260 per million population, respectively, in 2010. The next highest rate was reported by the United States, at 1,870, followed by Portugal, Singapore (2009), and Jalisco (Mexico) at 1,590, 1,524, and 1,402. The lowest rates were reported by Bangladesh and Russia, at 158 and 186. Data presented only for countries from which relevant information was available; “.” signifies data not reported. All rates unadjusted. ^UK: England, Wales, & Northern Ireland (Scotland data reported separately). Data for Belgium & England/Wales/Northern Ireland do not include patients younger than 18. **Argentina (2005–2007), Bangladesh, Brazil, Czech Republic (2005–2008), Japan, & Taiwan are dialysis only. *Latest data for Singapore & Morelos (Mexico) are for 2009. Data for France include 13 regions in 2005, 15 regions in 2006, 18 regions in 2007, 20 regions in 2008 & 2009, & 23 regions in 2010.

Dialysis

Figure 12.7 Percent distribution of prevalent dialysis patients, by modality, 2010

Table 12.c Percent distribution of prevalent dialysis patients, by modality &year

In Hong Kong, 75 percent of prevalent dialysis patients were treated with CAPD/CCPD in 2010. More than half of prevalent dialysis patients in Jalisco (Mexico) and Morelos (Mexico) use this therapy, as do 35 percent of those treated in New Zealand. In-center hemodialysis remains the most common mode of therapy worldwide; in New Zealand and Australia, however, 17.7 and 9.1 percent of patients, respectively, use home hemodialysis. Data presented only for countries from which relevant information was available; “.” signifies data not reported. All rates unadjusted. ^UK: England, Wales, & Northern Ireland (Scotland data reported separately). Data for Belgium & England/Wales/Northern Ireland do not include patients younger 18, respectively. *Latest data for Singapore & Morelos (Mexico) are for 2009. Data for France include 13 regions in 2005, 15 regions in 2006, 18 regions in 2007, 20 regions in 2008 & 2009, & 23 regions in 2010.

Transplantation

Figure 12.8 Prevalent rates of functioning grafts, 2010

Table 12.d Prevalent rates of functioning grafts, by year (per million population)

Reported prevalent rates of functioning grafts were greatest in Norway, the United States, and Portugal, at 608, 580, and 566 per million population in 2010. Countries and regions reporting rates above 400 per million include the Netherlands, Spain, Sweden, Belgium (both French- and Dutch-speaking), Austria, Jalisco (Mexico), Canada, the UK, France, Finland, Hong Kong, and Scotland. Bosnia/Herzegovina, Russia, Romania, and Morelos (Mexico) reported rates below 50 per million population in 2010. Data presented only for countries from which relevant information was available; “.” signifies data not reported. All rates unadjusted. ^UK: England, Wales, & Northern Ireland (Scotland data reported separately). Data for Belgium & England/Wales/Northern Ireland do not include patients younger than 18. *Latest data for Singapore & Morelos (Mexico) are for 2009. Data for France include 13 regions in 2005, 15 regions in 2006, 18 regions in 2007, 20 regions in 2008 &2009, &23 regions in 2010.

Figure 12.9 Transplant rates, 2010

Table 12.e Transplant rates, by year (per million population)

Jalisco (Mexico), the United States, Portugal, Norway, the UK, and the Netherlands reported transplant rates of 63.2, 57.5, 54.3, 53.8, 53.3, and 52.8, respectively, per million population in 2010. Rates were less than 10 per million, in contrast, in Malaysia, Russia, Romania, Bosnia and Herzegovina, Thailand, and Bangladesh. Data presented only for countries from which relevant information was available; “.” signifies data not reported. All rates unadjusted. ^UK: England, Wales, &Northern Ireland (Scotland data reported separately). Data for Belgium &England/Wales/Northern Ireland do not include patients younger than 18. *Latest data for the Singapore & Morelos (Mexico) are for 2009. Data for France include 13 regions in 2005, 15 regions in 2006, 18 regions in 2007, 20 regions in 2008 & 2009, & 23 regions in 2010.