Format

Send to

Choose Destination
Lancet. 2015 May 16;385(9981):1975-82. doi: 10.1016/S0140-6736(14)61601-9. Epub 2015 Mar 13.

Worldwide access to treatment for end-stage kidney disease: a systematic review.

Author information

1
George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia.
2
George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
3
George Institute for Global Health, Splendor Forum, Jasola New Delhi, India; Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
4
Department of Clinical Sciences, Faculty of Medicine, University of Douala, Douala, Cameroon.
5
Division of Internal Medicine, University of Cape Town, Cape Town, South Africa.
6
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
7
Department of Medicine, and Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
8
George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Menzies School of Health Research, Charles Darwin University, NT, Australia.
9
George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: vperkovic@georgeinstitute.org.au.

Abstract

BACKGROUND:

End-stage kidney disease is a leading cause of morbidity and mortality worldwide. Prevalence of the disease and worldwide use of renal replacement therapy (RRT) are expected to rise sharply in the next decade. We aimed to quantify estimates of this burden.

METHODS:

We systematically searched Medline for observational studies and renal registries, and contacted national experts to obtain RRT prevalence data. We used Poisson regression to estimate the prevalence of RRT for countries without reported data. We estimated the gap between needed and actual RRT, and projected needs to 2030.

FINDINGS:

In 2010, 2·618 million people received RRT worldwide. We estimated the number of patients needing RRT to be between 4·902 million (95% CI 4·438-5·431 million) in our conservative model and 9·701 million (8·544-11·021 million) in our high-estimate model, suggesting that at least 2·284 million people might have died prematurely because RRT could not be accessed. We noted the largest treatment gaps in low-income countries, particularly Asia (1·907 million people needing but not receiving RRT; conservative model) and Africa (432,000 people; conservative model). Worldwide use of RRT is projected to more than double to 5·439 million (3·899-7·640 million) people by 2030, with the most growth in Asia (0·968 million to a projected 2·162 million [1·571-3·014 million]).

INTERPRETATION:

The large number of people receiving RRT and the substantial number without access to it show the need to both develop low-cost treatments and implement effective population-based prevention strategies.

FUNDING:

Australian National Health and Medical Research Council.

PMID:
25777665
DOI:
10.1016/S0140-6736(14)61601-9
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center