New article in The Lancet provides a global overview of end stage kidney disease

Over two million people worldwide are being treated for end stage kidney disease (ESKD). In a new article published in The Lancet, investigators Bruce M Robinson, MD, Tadao Akizawa, MD, Kitty J Jager, MD PhD, Peter G Kerr, MD, Rajiv Saran, MD, and Ronald L Pisoni, PhD present international cohort study data to highlight differences in hemodialysis practice that influence survival and the experiences of patients who rely on this therapy. Data are derived from the United States Renal Data System (USRDS) Annual Data Report and from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

Dr. Bruce M Robinson, the lead author of this paper, commented, “This paper in The Lancet’s series on dialysis leveraged key findings from two important projects at Arbor Research, the DOPPS Program and the USRDS. The USRDS data highlight lessons learned from comparisons of ESKD patients across registries internationally. The DOPPS Program findings highlight the value of international comparisons of key in-center hemodialysis practices, highlighting opportunities to extend survival and improve the experiences of patients on dialysis. The paper was itself an international collaboration, with contributions from co-authors spanning four continents.”

In this paper, “Factors affecting outcomes among patients reaching end stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and hemodialysis practices,” researchers note that the incidence of ESKD is rising rapidly in many countries due to greater availability of dialysis or transplantation and increasingly older populations. In contrast, incidence rates are stable or declining in many countries with longstanding access to dialysis or transplantation, presumably due at least in part to greater success preventing chronic kidney disease or slowing its progression. At the same time, because patients with ESKD are surviving longer, the prevalence of ESKD will continue to rise even in countries with stable ESKD incidence.

Researchers also observed differences in modality use among patients with ESKD. Transplantation or home dialysis are widely considered preferable to in-center hemodialysis for many patients, yet use of these modalities ranges from more than two-thirds of patients in some countries to fewer than 10 percent in many others. Among the large majority of ESKD patients worldwide treated with in-center hemodialysis, survival is poor but generally improving.

Studying this international data allowed investigators to uncover some commendable practice patterns, including the high use of surgical vascular access in Japan and some European countries and the high use in some countries of longer or more frequent dialysis sessions. One outcome that remained consistent across countries was the especially high mortality rate soon after ESKD onset. Researchers recommend that practitioners work to provide earlier and more frequent pre-ESKD nephrology care to increase patient preparedness and improve patient experiences and survival in the early dialysis period.

Overall, upward trends in ESKD prevalence support the need for expanded dialysis and kidney transplantation services to meet the growing burden of ESKD worldwide. Examining major differences in dialysis practice between countries provides valuable insights into ways to improve outcomes for this growing population of patients.

CITATION:Robinson BM, Akizawa T, Jager KJ, Kerr PG, Saran R, Pisoni RL. Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. Lancet. 2016;388(10041):294-306.
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