Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices
- PMID: 27226132
- PMCID: PMC6563337
- DOI: 10.1016/S0140-6736(16)30448-2
Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices
Abstract
More than 2 million people worldwide are being treated for end-stage kidney disease (ESKD). This Series paper provides an overview of incidence, modality use (in-centre haemodialysis, home dialysis, or transplantation), and mortality for patients with ESKD based on national registry data. We also present data from an international cohort study to highlight differences in haemodialysis practices that affect survival and the experience of patients who rely on this therapy, which is both life-sustaining and profoundly disruptive to their quality of life. Data illustrate disparities in access to renal replacement therapy of any kind and in the use of transplantation or home dialysis, both of which are widely considered preferable to in-centre haemodialysis for many patients with ESKD in settings where infrastructure permits. For most patients with ESKD worldwide who are treated with in-centre haemodialysis, overall survival is poor, but longer in some Asian countries than elsewhere in the world, and longer in Europe than in the USA, although this gap has reduced. Commendable haemodialysis practice includes exceptionally high use of surgical vascular access in Japan and in some European countries, and the use of longer or more frequent dialysis sessions in some countries, allowing for more effective volume management. Mortality is especially high soon after ESKD onset, and improved preparation for ESKD is needed including alignment of decision making with the wishes of patients and families.
Copyright © 2016 Elsevier Ltd. All rights reserved.
Conflict of interest statement
Declaration of interests
BMR and RLP report grants from Amgen, Kyowa Hakko Kirin, Baxter Healthcare, European Renal Association/European Dialysis and Transplant Association (ERA-EDTA), Vifor Pharma Ltd, Hexal AG, AbbVie, Shire, German Society of Nephrology, Società Italiana di Nefrologia, Japanese Society for Peritoneal Dialysis, Keryx, and Genzyme Corporation. BMR reports personal fees from University of Toronto, Rhode Island Hospital, and Kyowa Hakko Kirin, outside of the submitted work. TA reports personal fees from Kyowa Hakko Kirin, and AbbVie Inc, during the conduct of the study; and reports personal fees from JT Pharmaceuticals Corporate, Kissei Pharmaceutical, Nipro Medical, Ono Pharmaceutical, Astellas, Bayer HealthCare, Chugai Pharmaceutical, Torii Pharmaceutical, Fuso Pharmaceutical, Teijin Pharma, and GlaxoSmithKline, outside of the submitted work. KJJ reports grants from ERA-EDTA, European Society for Paediatric Nephrology, International Pediatric Nephrology Association, and the Dutch Kidney Foundation, outside of the submitted work. PGK reports personal fees from Fresenius Australia and Quanta Fluid Solutions, outside of the submitted work. RLP reports personal fees from Kyowa Hakko Kirin and reports non-financial support from National Kidney Foundation, outside of the submitted work. RS declares no competing interests.
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