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 Figure 10.1Incidence rate of ESRD, per million population, by country, in 2012
 Figure 10.2Trends in the incidence rate of ESRD, per million population, by country, years 2000-2012
 Table 10.1Trends in the incidence rate of ESRD, per million population, by country, years 2006-2012
 Figure 10.3Percentage of incident ESRD patients with diabetes as the primary ESRD cause, by country, in 2012
 Figure 10.4Incidence rate of ESRD, per million population, by age group and country, in 2012
 Figure 10.5Prevalence of ESRD, per million population, by country, in 2012
 Table 10.2Number of ESRD prevalent patients and prevalence of ESRD, per million population, by country, years 2006-2012
 Figure 10.6Trends in the prevalence of ESRD, per million population, by country, years 2000-2012
 Figure 10.7Prevalence of dialysis, per million population, by country, in 2012
 Figure 10.8 Trends in the prevalence of dialysis, per million population, by country, years 2000-2012
 Table 10.3Trends in the prevalence of dialysis, per million population, by country, years 2006-2012
 Figure 10.9Distribution of the percentage of prevalent dialysis patients using in-center HD, home HD, and CAPD/CCPD, in 2012
 Table 10.4Distribution of the percentage of prevalent dialysis patients using in-center HD, home HD, and CAPD/CCPD, years 2006-2012
 Figure 10.10Kidney transplantation rate, per million population, by country, in 2012
 Table 10.5Kidney transplantation rates, per million population, by country, years 2006-2012
 Figure 10.11Prevalence of ESRD patients with a functioning kidney tranplant, per million population, by country, in 2012
 Table 10.6Trends in the prevalence of ESRD patients with a functioning kidney transplant, per million population, by country, years 2006-2012
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Chapter 10: International Comparisons

Introduction

This chapter provides a worldwide view of end-stage renal disease (ESRD). The number of countries and regions represented in this Annual Data Report has increased by more than 25 percent, from 42 countries in 2013 to 54 this year. Forty countries provided updated data for 2012; 14 new countries provided data this year, including Bahrain, Hungary, Indonesia, Iran, Italy (for 2010), Kuwait, Lebanon, Oman, Poland, Qatar, Saudi Arabia, Slovenia, South Africa, and Ukraine. This chapter is made possible only through the great efforts of many people across all participating countries, in contributing data for this international collaboration. We sincerely thank all of the registries and providers for their efforts, and have included a list at the end of this chapter to further acknowledge their contributions.

We hope these comparisons provide helpful global perspectives and increase awareness regarding the various aspects of ESRD described within this chapter. We welcome any suggestions to further improve the content of this chapter for the international community, and invite all renal registries to participate in this data collection and collaboration. We realize there are many countries not yet represented in this chapter, and that an unmet need exists for availability of dialysis in some communities. Efforts toward enhanced, broadened, and meaningful outreach will be a continued focus of this chapter.

Chapter Highlights

  • In 2012, ESRD incidence rates varied more than 15-fold by country, ranging from 25 to 467 new ESRD patients per million population. In most countries, ESRD incidence rates are highest among elderly patients (aged 75 or greater). The highest rate of ESRD incidence in younger individuals (ages 20-44 years old) was observed in the United States (U.S.), at more than twice the rate reported in the great majority of countries providing 2012 data.
  • Comparisons of the change in country average ESRD incidence rates between 2006 and/or 2007 and 2011 and/or 2012 were varied. In 40 percent of countries, relatively small changes were seen over this time period (±five percent change). In some countries, however, incidence rates increased by 29 to 70 percent; in other areas ESRD incidence rates declined by seven to 30 percent over this time period.
  • Prevalence of ESRD varied more than 20-fold across countries in 2012, from 131 per million population in Ukraine to 2,902 in Taiwan. In all countries reporting data from 2006 to 2011 or 2012, ESRD prevalence increased during this time period, ranging from a six to 135 percent overall rise (median rise of 17 percent; interquartile range: 13 to 35 percent).
  • In 2012, the proportion of new ESRD patients with diabetes as the primary cause differed greatly across countries, ranging from 66 and 61 percent of patients in Singapore and Malaysia, respectively, to 12–16 percent of new ESRD patients in Ukraine, Romania, and the Netherlands. In approximately half of all countries, diabetes was the primary cause of ESRD for at least 31 percent of new ESRD patients.
  • The number of ESRD patients receiving chronic dialysis per million population in 2012 varied more than 20-fold across countries, from 2,902 and 2,365 in Taiwan and Japan, respectively, to 133-185 in South Africa, Russia, and the Philippines. From 2006 to 2011 or 2012, the number of ESRD patients receiving dialysis per million population increased 1.5- to 2.5-fold across nearly 20 percent of reporting countries, and yet declined or reached an apparent plateau in nearly 25 percent of other reporting countries.
  • Although hemodialysis (HD) was the most common form of dialysis provided to ESRD patients in the great majority of countries in 2012, peritoneal dialysis (PD) was used by 73 percent and 50 percent of dialysis patients, respectively, in Hong Kong and in Jalisco (Mexico). Thirty-one percent of patients received PD in New Zealand and Colombia, and 17–27 percent use was reported in Australia, Canada, Denmark, Finland, Iceland, Qatar, South Africa, Sweden, and Thailand; numerous other countries reported 5–16 percent PD use. Although recent increases have been seen in peritoneal dialysis in countries such as Argentina, Hungary, Portugal, Thailand, and the U.S., approximately 40 percent of countries reporting data for most years between 2006 and 2012 displayed an overall decline in the percentage of PD use during this time period.
  • Home hemodialysis was provided to 19.0 percent and 9.2 percent of patients, respectively, in New Zealand and Australia in 2012. Furthermore, home HD was used by 3.0 to 5.7 percent of patients in Canada, Denmark, Finland, Sweden, the Netherlands, the United Kingdom (U.K.) 1 and Scotland, with numerous countries providing such treatment for up to two percent of dialysis patients.
  • Kidney transplantation rates varied 30-fold across countries, from two to 60 kidney transplants per million population in 2012 (median of 27 per million population). The highest kidney transplant rates were reported in Norway, Jalisco (Mexico), the Netherlands, the U.S., Croatia, and Spain, with 54–60 per million population. Substantial increases in kidney transplantation have been seen since 2006, in nearly 30 percent of reporting countries.
  • Large international variations are seen in the prevalence of ESRD patients living with a functioning kidney transplant. In 2012, Norway, Portugal, and the U.S. reported the highest prevalence of such ESRD patients at 594 to 639 per million population. In contrast, in approximately 25 percent of other countries, the prevalence of ESRD patients living with a functioning kidney transplant ranged from two to 106 per million population.
Analytical Methods

See the ESRD Analytical Methods chapter for the data collection form and for an explanation of the analytical methods used to generate the figures and tables in this chapter.

Incidence of End-Stage Renal Disease

In 2012, reported rates of the incidence of ESRD varied greatly across countries (see Figure 10.1). Jalisco (Mexico), Taiwan, and the U.S. reported the highest rates of ESRD incidence at 467, 450, and 359 per million population, respectively. Below this, ESRD incidence rates of 210–285 per million population were reported for Japan, Singapore, Bahrain, Hungary, Malaysia, Republic of Korea, Thailand, Portugal, and Greece. Much lower ESRD incidence rates of 25 to 100 per million population were reported in Ukraine, Russia, Qatar, Iceland, Finland, and Scotland. In all other countries, incident ESRD rates ranged from 103 to 191 per million population.

Figure 10.1 Incidence rate of ESRD, per million population, by country, in 2012

As illustrated by Figure 10.2 and Table 10.1, substantial differences are seen across countries regarding the overall trend in ESRD incidence from 2006 to 2011 or 2012. In comparing the average ESRD incidence in 2006 and 2007 versus that in 2011 and 2012, rates increased by 29 to 70 percent in Romania, Russia, Malaysia, Thailand, the Philippines, Jalisco (Mexico), and Chile, while increasing seven to 16 percent in Uruguay, Argentina, Republic of Korea, Singapore, Hong Kong, and Turkey. In contrast, rates of ESRD incidence declined by seven to 14 percent over this time period in Finland, Sweden, Denmark, Scotland, Austria, and Bosnia and Herzegovina, with Colombia reporting a large 32 percent average decline during the same time period. However, nearly 40 percent of all countries reported a relatively stable rate of ESRD incidence from 2006 to 2012, including the U.S., which showed little overall change (0.7 percent decline).

Figure 10.2 Trends in the incidence rate of ESRD, per million population, by country, years 2000-2012

Table 10.1 Trends in the incidence rate of ESRD, per million population, by country, years 2006-2012

Diabetes as Primary Cause of End-Stage Renal Disease in Incident Patients

The distribution of primary causes of ESRD varies substantially across countries (see Figure 10.3). Data on one of the key primary causes of ESRD, diabetes mellitus (DM), were provided by nearly 75 percent of the countries participating in this report. In 2012, Singapore and Malaysia reported the highest rate of patients with new ESRD due to DM, at 66 and 61 percent, respectively. Furthermore, DM was the primary cause of new ESRD for 48 to 59 percent of patients in Jalisco (Mexico), Kuwait, Oman, Israel, Republic of Korea, Hong Kong, and New Zealand. In contrast, in some countries, DM as the primary cause of ESRD was one-third to one-quarter that of the above countries. Thus, in Iran, Russia, Romania, Ukraine, France, Belgium, the Netherlands, and Norway, diabetes was the primary cause for less than 22 percent of new patients in 2012.

Figure 10.3 Percentage of incident ESRD patients with diabetes as the primary ESRD cause, by country, in 2012

Incidence of End Stage Renal Disease by Age Group

When examined across four age categories, the rate of new ESRD was typically highest among patients aged 75 years and older in the great majority of countries. In some cases the ESRD incidence rate was more than 1.5-fold higher for this older patient cohort, compared with those 65-74 years old (see Figure 10.4). The highest ESRD incidence rates were reported in Poland, Taiwan, and the U.S. for patients aged 75 years and older, amounting to 4,053, 2,840, and 1,415 per million population of older individuals, respectively, in 2012. Conversely, in Argentina, Hong Kong, Malaysia, Romania, Serbia, and Scotland, the ESRD incidence rate was lower among patients aged 75 years or older than for patients 65-74 years old. Furthermore, the highest rate of ESRD incidence in younger adults (ages 20-44 years old) was seen in the U.S., which was more than twice that reported in the great majority of countries reporting 2012 data.

Figure 10.4 Incidence rate of ESRD, per million population, by age group and country, in 2012

Prevalence of End-Stage Renal Disease

In 2012, ESRD prevalence, indicated as the number of treated ESRD patients per million population on December 31, 2012, was highest in Taiwan, Japan, and the U.S., at 2,902, 2,365, and 1,976 per million population, respectively. Furthermore, in 2012 ESRD prevalence ranged from 1,023 to 1,741 per million population in 33 percent of countries, and from 578 to 996 in 50 percent of countries (see Figure 10.5 and Table 10.2). The lowest rates were reported in Ukraine, Russia, Qatar, Bahrain, Indonesia, and South Africa, where treated ESRD prevalence rates varied from 131 to 328 per million population.

Figure 10.5 Prevalence of ESRD, per million population, by country, in 2012

Table 10.2 Number of ESRD prevalent patients and prevalence of ESRD, per million population, by country, years 2006-2012

Since 2006, the prevalence of ESRD has been continually rising in nearly all of the countries that provided data for all or most of the 2006-2012 time frame. These results indicate the continuing worldwide need for additional resources and care on a broad, global level to meet the health needs of individuals with ESRD. As seen in Figure 10.6, some countries have shown particularly large rises in ESRD prevalence between 2006 and 2011 or 2012, including Malaysia, Russia, Brazil, the Philippines, the Czech Republic, Romania, and Thailand, where ESRD prevalence has increased 55 to 135 percent.

In 2012, the total number of patients treated for ESRD was by far the highest in the U.S., with nearly 600,000 treated patients, followed by Japan and Brazil with approximate cohorts of 301,000 and 144,000, respectively. France, Spain, Taiwan, Thailand, Turkey, and the U.K. reported between 50,000 to 70,000 treated ESRD patients in 2012, with all other countries treating smaller groups, with a median of approximately 9,000 treated patients.

Figure 10.6 Trends in the prevalence of ESRD, per million population, by country, years 2000-2012

Dialysis Therapy for ESRD

Dialysis is the most commonly utilized therapeutic approach for treatment of ESRD, followed by kidney transplantation. The number of ESRD patients receiving chronic dialysis per million population in 2012 varied more than 20-fold across countries, from 2,902 and 2,365 in Taiwan and Japan, respectively, to a range of 133 to 185 in South Africa, Russia, and the Philippines (see Figure 10.7). Between 2006 to 2011 or 2012, a large 1.5- to 3.1-fold increase was reported in the number of ESRD patients receiving dialysis per million population in Thailand, the Philippines, Bangladesh, Malaysia, Romania, Russia, Oman (between 2008 to 2012), and Jalisco (Mexico). However, a plateauing or decline in the prevalence of treated ESRD patients receiving chronic dialysis is beginning to be seen in nearly a quarter of all countries reporting several years of data (see Figure 10.8 and Table 10.3). These countries include Austria, Slovenia, Denmark, Finland, Norway, Sweden, the Netherlands, Scotland, Spain, and Uruguay.

Figure 10.7 Prevalence of dialysis, per million population, by country, in 2012

Figure 10.8 Trends in the prevalence of dialysis, per million population, by country, years 2000-2012

Table 10.3 Trends in the prevalence of dialysis, per million population, by country, years 2006-2012

Hemodialysis continues to be the most common form of dialysis therapy in nearly all countries; in over 60 percent of reporting countries at least 80 percent of chronic dialysis patients were receiving HD (Figure 10.9). However, in 2012 PD was used by 73 percent of dialysis patients in Hong Kong, and 50 percent in Jalisco (Mexico). Furthermore, 31 percent PD use was reported in New Zealand and Colombia, and 17 to 27 percent in Australia, Canada, Denmark, Finland, Iceland, Qatar, South Africa, Sweden, and Thailand. As seen in Table 10.4, since 2006, an overall trend of increasing peritoneal dialysis use as a percentage of all chronic dialysis has been seen in such countries as Argentina, Hungary, Portugal, and Thailand. In contrast, PD use has declined over this same time period in countries such as the Flemish region of Belgium, Colombia, Denmark, Finland, France, Greece, Hong Kong, Israel, Jalisco (Mexico), Republic of Korea, the Netherlands, New Zealand, Norway, Romania, Scotland, Singapore, Turkey, and the U.K. Home HD therapy was provided to 19.0 and 9.2 percent of dialysis patients, respectively, in New Zealand and Australia in 2012. Home HD was also used by 3.0 to 5.7 percent of dialysis patients in Canada, Denmark, Finland, Sweden, the Netherlands, the U.K., and Scotland. However, in all other countries, home HD was either not provided, or used by fewer than two percent of dialysis patients.

Figure 10.9 Distribution of the percentage of prevalent dialysis patients using in-center HD, home HD, and CAPD/CCPD, in 2012

Table 10.4 Distribution of the percentage of prevalent dialysis patients using in-center HD, home HD, and CAPD/CCPD, years 2006-2012

Transplantation

Kidney transplantation rates vary greatly across countries, which may reflect not only geographic variations in ESRD incidence and prevalence rates but also differences in national health care systems, infrastructure, organ availability, and cultural beliefs. Among the countries represented in this international chapter, kidney transplant rates varied 30-fold across countries, from two to 60 kidney transplants per million population in 2012 (see Figure 10.10). The highest kidney transplant rates were reported in Norway, Jalisco (Mexico), the Netherlands, the U.S., Croatia, and Spain with 54–60 kidney transplants per million population. Among other countries, kidney transplantation rates ranged from 30–47 per million population for 40 percent of countries, to 12–28 per million population for 30 percent of countries, and 2–7 per million population for 20 percent of countries. Countries reporting these lowest rates of kidney transplantation included Ukraine, Malaysia, the Philippines, South Africa, Qatar, Russia, Romania, Bosnia and Herzegovina, and Thailand. As shown in Table 10.5, since 2006 a substantial increase has been seen in kidney transplant rates in some countries, including Argentina, Australia, Brazil, Denmark, Saudi Arabia, Republic of Korea, Poland, Spain, Turkey, and the U.K. In contrast, kidney transplant rates appear to have declined over this time period in the Czech Republic, Greece, Malaysia, Israel, Singapore, and the Philippines.

Figure 10.10 Kidney transplantation rate, per million population, by country, in 2012

Table 10.5 Kidney transplantation rates, per million population, by country, years 2006-2012

In 2012, Norway, Portugal, and the U.S. reported the highest prevalence of ESRD patients living with a kidney transplant, at 594 to 639 per million population (Figure 10.11 and Table 10.6). Seventy percent of other participating countries reported distributions within the broad mid-range of 168 to 554 prevalent ESRD patients living with a kidney transplant per million population. The remaining 25 percent of countries had the lowest prevalence, ranging from two to 106 per million population.

Figure 10.11 Prevalence of ESRD patients with a functioning kidney tranplant, per million population, by country, in 2012

Table 10.6 Trends in the prevalence of ESRD patients with a functioning kidney transplant, per million population, by country, years 2006-2012

Acknowledgements

We would like to greatly thank the following contributors - Australia and New Zealand Dialysis and Transplant Registry, Sergio Marinovich (Argentina), Anneke Kramer (Austria, Belgium, Bosnia and Herzegovina, Croatia, Denmark, Finland, Greece, Iceland, the Netherlands, Norway, Romania, Serbia, Slovenia, Sweden), Sumaya Al Ghareeb (Bahrain), Bangladesh Renal Registry, Jocemir Lugon (Brazil), Juliana Wu and Norma Hall (Canada), Hugo Poblete (Chile), Rafael Gomez and Cuenta de Alto Costo (Colombia), The Czech Registry of Dialysis Patients, Cecile Couchoud and Mathilde Lassalle (France), C.B. Leung and Yiu Wing Ho (Hong Kong), G.S. Reusz and Sandor Mihaly (Hungary), Afiatin Maman and Dheny Sarli (Indonesia), Mitra Mahdavi-Mazdeh and Katayoun Najafizadeh (Iran), Eliezer Golan (Israel), Maurizio Postorino (Italy), Ikuto Masakane (Japan), Ali Alsahow (Kuwait), Hafez Elzein (Lebanon), Lee Day Guat (Malaysia), Guillermo Garcia Garcia (Mexico—Jalisco), Instituto Mexicano De Trasplantes (Mexico—Morelos), Ahmed Said Al Busaidi, Yacoub Almaimani and Issa Alsalmi (Oman), Gilan Ortomio and Arlene Munoz (the Philippines), Andrzej Wiecek, Marian Klinger and BolesÅ‚aw Rutkowski (Poland), Fernando Macario (Portugal), Fadwa Al Ali and Rania A /Aziz Mohd Ibrahim (Qatar), Boris Bibkov (Russia), Faissal Shaheen (Saudi Arabia), Wendy Metcalfe (Scotland), Gek Hsiang (Singapore), Razeen Davids (South Africa), Dong-Chan Jin (Republic of Korea), Eduardo Martín Escobar (Spain), C.C. Huang and Hung-Chun Chen (Taiwan), Kearkiat Praditpornsilpa (Thailand), Nurhan Seyahi, Gültekin Süleymanlar, Mehmet Riza Altiparmak and Sinan Trabulus (Turkey), Ukrainian Renal Registry, Fergus Caskey and Anna Casula (United Kingdom), María Carlota González-Bedat and Francisco González-Martínez (Uruguay) and Kamyar Kalantar-Zadeh.


1 U.K. data represents England, Wales, Northern Ireland; data for Scotland is reported separately.