international comparisons

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������������������ � ��introduction

Not only does such information allow for in-ternational comparisons; it also provides a con-text 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 con-siderable challenges each country faces in gath-ering 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. Taiwan, the U.S., and Japan continue to have some of the highest rates, at 384, 362, and 288 per million population. And in Mexico, rates in Morelos and Jalisco reached 557 and 400, respectively.

The high and rising rates noted in Taiwan have been of great interest, as they eclipse rates reported in the rest of the world. It had appeared that such growth would continue, but rates now seem to have peaked, with a recent decline paralleling that seen in the U.S. Recent changes to pay-ment policies for treated ESRD populations in Taiwan may impact these lower rates. More importantly, there have been a number of initiatives to address the care of patients with CKD and diabetes. More time is need to determine if this improvement can be sustained, given the aging of the Taiwanese population and its high burden of diabetes.

This year we introduce comparisons of ESRD incidence among Asian populations in Japan, Taiwan, and the U.S., and among native populations in Australia, New Zealand, the U.S., and Canada. These comparisons are the direct result of a significant collaboration between the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), the Japanese Society of Dialysis Therapy (JSDT), the Taiwan Society of Nephrology (TSN), and the Canadian Organ Replacement Registry (CORR). The almost universal voluntary reporting by these systems make them distinct in the way they capture information on treated ESRD. We have selected similar populations within the U.S. to highlight trends in ESRD and changes in the burden of kidney failure. Each of these countries has a unique health care delivery system, and unique issues in access to care. They also have high relative incomes per capita and advanced systems both of general health care and of public healthcare to address major chronic diseases. In Taiwan and Japan, for example, all populations receive universal health care cov-

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Incidence

2001 2002 2003 2004 2005 2006 2007 2008

Inci

dent

rate

per

mill

ion

popu

latio

n

50

100

150

200

250

300

350

400

450

Argentina

Brazil

Canada Greece

Hong Kong

Luxembourg

Netherlands

New Zealand

Philippines

Poland

Turkey

United States

Japan

Taiwan

2001 2002 2003 2004 2005 2006 2007 2008

Prev

alen

t rat

e pe

r mill

ion

popu

latio

n

0

300

600

900

1,200

1,500

1,800

2,100

2,400Prevalence

Argentina

Brazil

Canada Greece

Hong Kong

Luxembourg

Netherlands New Zealand

Philippines

Poland

Turkey

United States

Japan

Taiwan

�������

erage, and dialysis therapy has been available for many years. In the U.S., universal coverage applies only to ESRD, but has recently expanded under new legislation.

This is the first in a series of collaborations between the USRDS and ESRD surveillance systems around the world, as we work to provide new perspectives on treated ESRD in unique populations with different healthcare systems. We wish once again to thank JSDT, TSN, CORR, and ANZDATA for their collaboration. Data will be sent to each of the participating countries for further analysis and for presentation within their own registries, and the USRDS will provide web links to these data as well.�� ���������������������������� ��������������All rates unadjusted. Data from Argentina (pre-2008), Brazil, Japan, Luxembourg, & Taiwan are dialysis only.

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��1ii Comparison of unadjusted ESRD incidence & prevalence worldwide

Tropic of Cancer

Tropic of Capricorn

Equator

Antarctic CircleAntarctic Circle

ATLANTIC

PACIFIC

OCEAN

OCEAN

ARCTICOCEAN

United States

Jalisco

Morelos

Brazil

Argentina

Chile

Uruguay

Canada

108 130 153 189

esrd

worldwide view of the incidence of esrd

Data present-ed only for those countries from which relevant infor-

mation was available. All rates are unadjusted. Data from Bangladesh, Brazil, Czech

Republic, Japan, Luxembourg, & Taiwan are dialysis only. Lat-

est data for Hungary are for 2007. Data for

France included 18 regions in 2008.

Tropic of Cancer

Equator Equator

Tropic of Capricorn

Antarctic Circle Antarctic Circle

PACIFIC

INDIAN

OCEAN

OCEAN

ARCTIC OCEAN

Iran

Malaysia

Japan

Taiwan

Philippines

S. Korea

Thailand

Hong Kong

Pakistan

Bangladesh

Russia

Australia

New Zealand

Spain

Norway

Greece

Israel

Turkey

Iceland

United Kingdom

Scotland

Sweden

HungaryAustria

Czech RepublicGermany

Netherlands

BelgiumLuxembourg

France

Finland

Denmark

Bos & Herz.

CroatiaItaly

Poland

Romania

2ii Geographic variations in the incidence of ESRD, 2008

Rate per million population0 200 400 600

Bangladesh*Russia

IcelandPhilippines

FinlandRomaniaThailandScotland

UK^Norway

New ZealandAustralia

NetherlandsSweden

DenmarkSpain

PolandMalaysia

ArgentinaFranceAustriaBrazil*

Bosnia/Herzegov.Hong Kong

ChileCroatiaCanada

Hungary**Uruguay

Czech Republic*Rep. of Korea

Belgium, Dutch sp.Israel

Belgium, French sp.Greece

Luxembourg*TurkeyJapan*

United StatesTaiwan*

Jalisco (Mexico)Morelos (Mexico) 2003 2004 2005 2006 2007 2008

Argentina . 137 140 141 151 144Australia 100 97 113 118 113 116Austria 140 161 154 159 154 147Bangladesh 8 7 8 8 13 13Belgium, Dutch speaking 175 181 183 192 189 189Belgium, French speaking 161 186 177 187 187 190Bosnia/Herzegovina 106 108 104 133 151 149Brazil . . 177 185 140 148Canada 162 164 164 166 167 164Chile 130 157 135 141 144 153Croatia 131 155 144 142 153 153Czech Republic 167 166 175 186 185 182Denmark 132 131 121 120 146 125Finland 95 97 97 87 93 95France . . 140 144 140 146Greece 180 197 194 197 191 199Hong Kong 128 141 145 149 147 152Hungary 139 139 162 159 165 .Iceland 73 79 67 69 84 72Israel 188 189 186 192 193 189Jalisco (Mexico) 280 346 302 346 372 400Japan 263 267 271 275 285 288Rep. of Korea 152 171 173 185 184 182Luxembourg 180 188 164 224 155 227Malaysia 106 114 121 137 143 139Morelos (Mexico) . . . . 553 557Netherlands 103 106 107 112 117 121New Zealand 115 113 111 119 110 115Norway 96 101 99 100 113 112Philippines 60 75 74 80 93 87Poland 103 97 120 122 127 130Romania . . 94 75 90 96Russia 19 17 24 28 . 35Scotland 121 115 125 116 114 106Spain . 175 126 131 121 128Sweden 122 123 121 130 129 122Taiwan 391 405 432 417 421 384Thailand 78 123 110 139 159 100Turkey 112 121 179 192 229 261United States 343 348 354 366 362 362Uruguay 146 151 146 138 143 166U.K. (England, Wales & N Ireland) . 100 111 115 116 108

esrd

incidence of end-stage renal disease

3ii Incidence ofESRD, 2008 aii

Incidence of ESRD, by year(per million population)

Incident rates of reported ESRD in 2008 were greatest in Morelos (Mexico), at 557 per million population, followed by Jalisco (Mexico), Taiwan, the United States, and Japan at 400, 384, 362, and 288, respectively. Rates of less than 100 per million were reported in Romania, Finland, the Philip-pines, Iceland, Russia, and Bangladesh. As stated in previous ADRs, it is important to note the dis-

tinction between the incidence of treatment guid-ed by available funding, and the incidence of the disease itself. An affluent nation may allow elderly patients and those with diabetes to receive hemo-dialysis, for example, while developing nations may restrict their treatment to younger, healthier patients.

InII

Percent of patients0 15 30 45 60

Romania

Bosnia/Herzegov.

Russia

Iceland

Netherlands

Norway

Poland

UK^

France

Spain

Denmark

Scotland

Belgium, Dutch sp.

Belgium, French sp.

Sweden

Uruguay

Turkey

Greece

Hungary**

Croatia

Austria

Finland

Australia

Canada

Brazil*

Argentina

Thailand

Philippines

Hong Kong

Israel

Rep. of Korea

Japan*

United States

Taiwan*

New Zealand

Jalisco (Mexico)

Malaysia

Morelos (Mexico) 2003 2004 2005 2006 2007 2008

Argentina . 31.4 34.7 33.8 33.2 35.4Australia 26.0 30.3 31.6 32.7 31.1 34.0Austria 33.5 32.3 33.5 33.0 31.6 31.9Belgium, Dutch speaking 24.0 24.4 24.2 22.3 23.4 23.1Belgium, French speaking 25.0 21.2 23.7 22.5 22.8 23.2Bosnia/Herzegovina 22.9 20.1 20.6 21.5 19.7 16.3Brazil . . . . . 34.5Canada 34.2 34.4 34.8 34.3 34.7 34.2Croatia 26.9 29.0 30.0 28.0 32.0 31.0Denmark 22.6 21.5 24.2 23.8 23.2 22.8Finland 34.9 33.2 34.6 35.7 35.8 33.3France . . 22.9 33.8 21.9 22.5Greece 28.0 28.3 29.3 29.5 27.7 29.1Hong Kong 39.9 40.5 41.1 40.2 45.1 41.3Hungary 25.5 29.5 26.2 27.5 29.2 .Iceland 0.0 4.3 5.0 28.6 11.5 17.4Israel 39.0 42.2 40.7 41.9 41.8 41.4Jalisco (Mexico) 51.0 56.0 60.0 49.9 55.0 54.6Japan 40.6 40.9 41.6 42.5 43.2 43.2Rep. of Korea 42.5 43.4 38.5 42.3 44.9 41.9Malaysia 53.9 55.1 55.9 59.2 58.5 55.8Morelos (Mexico) . . . . 52.0 59.8Netherlands 16.6 17.4 15.6 16.2 18.2 18.1New Zealand 41.3 40.7 42.2 42.3 41.0 45.5Norway 15.8 17.3 12.8 16.5 13.6 18.2Philippines 32.8 33.5 36.5 38.6 38.6 40.7Poland 22.6 26.9 27.2 29.6 24.1 20.6Romania . . 10.7 12.3 11.7 12.5Russia 10.7 . 11.0 13.9 . 17.2Scotland 18.9 17.9 22.1 22.1 20.4 22.8Spain . 17.5 23.2 19.6 21.5 22.6Sweden 24.0 25.1 25.9 26.0 27.5 23.7Taiwan 36.8 40.1 42.0 43.5 44.8 44.4Thailand . . . . 40.3 40.6Turkey 23.1 21.3 30.2 23.1 22.8 27.0United States 44.2 44.4 44.1 44.3 43.9 43.8Uruguay 29.6 21.8 29.6 22.1 22.1 23.8U.K. (England, Wales & N Ireland) . 19.1 17.1 18.8 19.7 20.6

4ii Percentage of incident patients with ESRD due to diabetes, 2008 bii

Percentage of incident patients with ESRD due to diabetes, by year

In 2008, diabetes was the primary cause of ESRD in 59.8, 55.8, and 54.6 percent of new patients in Morelos (Mexico), Ma-laysia, and Jalisco (Mexico). Hong Kong, Israel, Japan, the Republic of Korea, New Zealand, the Philippines, Taiwan, Thailand, and the United States, all have rates of ESRD inci-dence due to diabetes of greater than 40 percent. Countries reporting rates below 20 percent include Bosnia and Her-zegovina, Iceland, the Netherlands, Norway, Romania, and Russia.

InInIInInIIII

Data presented only for those countries from which relevant information was available; “.” sig-nifies data not reported. All rates are unadjusted.

^UK: England, Wales, & Northern Ireland, age 18+, (Scotland data reported separately). *Data from Bangladesh, Brazil, Czech Republic, Japan, Lux-embourg, & Taiwan are dialysis only; Argentina data prior to 2008 are dialysis only. **Latest data for Hungary are 2007. Data for France include 13 regions in 2005, 15 regions in 2006, 18 regions in 2007, & 20 regions in 2008.

Rate per million population

0 600 1,200 1,800 2,400

PhilippinesBangladesh*

RussiaBrazil*

RomaniaThailand

IcelandCzech Republic*

Luxembourg*Bosnia & Herzegov.

Hungary**Poland

MalaysiaTurkey

ArgentinaFinland

UK^New Zealand

AustraliaNorway

ScotlandDenmark

NetherlandsSwedenCroatia

Morelos (Mexico)Austria

SpainUruguay

Jalisco (Mexico)Rep. of Korea

GreeceFrance

ChileHong Kong

IsraelCanada

Belgium, Dutch sp.Belgium, French sp.

United StatesJapan*

Taiwan*Prevalent counts Prevalent rates

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Argentina 21,034 22,333 23,306 24,218 30,035 550 579 598 615 756 Australia 14,275 15,175 16,112 16,808 17,168 710 746 782 800 803 Austria 6,925 7,232 7,512 7,737 7,920 854 889 909 934 951 Bangladesh 10,274 11,565 12,864 15,089 16,963 70 78 86 99 112 Belgium, Dutch sp. 5,728 6,023 6,324 6,595 6,871 950 994 1,037 1,074 1,115 Belgium, French sp. 4,335 4,516 4,763 4,976 5,194 987 1,022 1,070 1,109 1,153 Bosnia/Herzegov. 1,867 2,009 2,115 2,306 2,441 487 524 552 602 637 Brazil 65,121 70,872 73,605 87,044 77,589 368 389 398 466 415 Canada 31,057 32,467 33,873 35,255 36,494 972 1,006 1,038 1,069 1,096 Chile 13,450 14,160 15,353 16,360 17,856 841 866 930 986 1,065 Croatia 3,582 3,708 3,799 3,932 4,009 807 836 856 886 904 Czech Republic 7,743 4,638 4,752 5,190 5,633 758 452 462 500 538 Denmark 4,125 4,219 4,305 4,545 4,683 756 770 784 824 844 Finland 3,601 3,755 3,828 3,947 4,081 689 716 727 746 768 France . 31,151 34,626 52,410 57,878 . 917 957 1,006 1,052 Greece 10,207 10,641 10,961 11,301 11,607 923 958 983 1,010 1,033 Hong Kong 6,307 6,635 6,930 7,155 7,445 928 970 1,003 1,029 1,065 Hungary 6,310 5,901 6,976 6,473 . 622 590 699 650 . Iceland 139 141 146 159 165 476 475 481 512 520 Israel 6,364 6,747 7,125 7,472 7,826 935 974 1,010 1,041 1,071 Jalisco (Mexico) 3,170 5,455 6,357 6,865 7,218 508 808 929 986 1,030 Japan 236,334 240,170 249,718 262,968 271,471 1,851 1,880 1,954 2,058 2,126 Rep. of Korea 41,891 44,333 46,730 48,675 51,989 854 900 942 973 1,032 Luxembourg 209 224 240 245 292 486 498 522 521 608 Malaysia 13,479 15,086 16,810 18,748 20,589 527 577 631 690 743 Morelos (Mexico) . . . 1,447 1,561 . . . 878 939 Netherlands 11,457 11,970 12,611 13,142 13,895 704 733 771 802 845 New Zealand 3,000 3,117 3,243 3,352 3,383 734 754 775 793 792 Norway 3,255 3,386 3,510 3,692 3,890 709 732 753 784 816 Philippines 4,375 7,676 7,437 7,967 10,552 52 91 86 90 110 Poland 19,160 20,479 21,765 23,658 24,783 502 537 571 621 650 Romania . 5,504 6,574 7,918 9,067 . 254 305 367 421 Russia 14,720 16,483 18,486 . 22,234 102 115 130 . 157 Scotland 3,713 3,877 3,999 4,156 4,241 731 761 782 808 821 Spain 39,578 28,366 35,462 41,546 44,067 1,098 868 961 956 995Sweden 7,275 7,408 7,710 7,913 8,044 809 820 849 865 872Taiwan 45,360 47,849 50,230 52,415 53,242 1,999 2,101 2,196 2,283 2,311Thailand 15,083 13,741 17,967 26,457 31,496 243 220 286 420 497Turkey 31,251 33,014 42,992 50,221 53,859 433 451 589 711 753UK^ 34,022 33,085 35,510 40,773 43,338 622 600 640 730 771United States 456,141 474,744 495,405 515,290 535,166 1,550 1,599 1,652 1,702 1,752Uruguay 2,895 2,807 3,073 3,204 3,389 893 849 927 964 1,020

Data presented only for those countries from which relevant information was available; “.” signifies data not reported. All rates are unad-justed. ̂ UK: England, Wales, & Northern Ireland (Scotland data reported separately). *Data from Bangladesh, Brazil, Czech Republic, Japan, Lux-embourg, & Taiwan are dialysis only. Argentina data prior to 2008 are dialysis only. **Latest data for Hungary are 2007. Data for France include 13 regions in 2005, 15 regions in 2006, 18 regions in 2007, & 20 regions in 2008.

esrd

prevalence of end-stage renal disease; dialysis

5ii Prevalence ofESRD, 2008 cii

Prevalence of ESRD, by year(per million population)

Taiwan and Japan continue to report the greatest rates of prevalent ESRD, at 2,311 and 2,126 per million population, respectively, in 2008. The next highest rate is reported by the United States, at 1,752, followed by French-speaking and Dutch-speaking Belgium, at 1,153 and 1,115, respectively. The lowest rates are reported by Bangladesh and the Philippines, at 112 and 110.

TT

Percent of patients0 20 40 60 80 100

LuxembourgBangladesh

JapanArgentina

Chile

Bosnia/ Herzegov.Israel

PhilippinesPoland

United StatesCroatia

Czech RepublicGreece

Hungary**Austria

UruguayRussia

Belgium, French sp.Taiwan

SpainThailandMalaysia

Belgium, Dutch sp.Brazil

FranceTurkey

NorwayRomaniaScotland

UK^

Rep. of KoreaCanada

NetherlandsIcelandFinland

SwedenDenmarkAustralia

New ZealandMorelos (Mexico)

Jalisco (Mexico)Hong Kong

In-center HD

Home HD

CAPD/CCPD

Hemodialysis Home hemodialysis Peritoneal dialysis

2004 2005 2006 2007 2008 2004 2005 2006 2007 2008 2004 2005 2006 2007 2008

Argentina 95.6 96.0 96.0 96.1 96.0 0.0 0.0 0.0 0.0 0.0 4.4 4.0 4.0 3.9 4.0Australia 67.6 68.9 68.2 68.2 68.6 10.0 9.5 9.7 9.8 9.4 22.4 21.5 22.1 22.0 22.0Austria 92.3 92.1 90.9 91.2 91.2 0.2 0.2 0.2 0.1 0.0 7.5 7.7 8.9 8.7 8.8Bangladesh 98.8 98.6 99.6 100 98.4 0.0 0.0 0.0 0.0 0.0 1.2 1.4 0.4 0.0 1.6Belgium/Dutch sp. 88.5 88.8 89.1 89.2 89.7 0.2 0.2 0.2 0.2 0.3 11.3 11.0 10.7 10.6 10.0Belgium, French sp. 89.8 89.5 89.1 90.4 90.9 1.2 1.2 1.3 1.2 1.3 9.0 9.3 9.6 8.4 7.8Bosnia/Herzegov. 96.2 95.7 95.3 95.2 95.1 0.0 0.0 0.0 0.1 0.0 3.8 4.3 4.7 4.7 4.9Brazil 89.0 90.7 90.8 89.4 89.6 0.0 0.0 0.0 0.0 0.0 11.0 9.3 9.2 10.6 10.4Canada 79.1 78.9 78.8 78.6 78.3 2.0 2.5 2.8 3.0 3.3 18.9 18.7 18.4 18.4 18.4Chile 94.0 94.3 95.0 95.2 95.3 0.02 0.02 0.02 0.02 0.01 6.0 5.6 5.0 4.8 4.7Croatia 91.1 90.8 91.6 92.8 91.8 0.0 0.0 0.0 0.0 0.0 8.9 9.2 8.4 7.2 8.2Czech Republic 92.5 92.5 92.4 92.3 91.8 0.02 0.00 0.00 0.00 0.00 7.5 7.5 7.6 7.7 8.2Denmark 73.0 72.2 71.8 71.2 72.1 2.3 3.1 4.1 4.3 4.6 24.7 24.8 24.1 24.5 23.2Finland 75.6 75.5 75.9 75.8 74.5 3.4 3.1 2.9 3.8 4.0 21.0 21.3 21.2 20.4 21.6France . 85.2 85.4 87.3 87.8 . 2.6 2.1 1.6 1.3 . 12.2 12.6 11.1 10.9Greece 90.6 91.0 91.5 91.7 91.7 0.01 0.01 0.01 0.01 0.01 9.4 9.0 8.4 8.3 8.3Hong Kong 17.9 17.7 18.8 19.5 20.2 0.03 0.03 0.05 0.19 0.41 82.1 82.2 81.1 80.3 79.4Hungary 93.4 87.2 87.3 91.3 . 0.0 0.0 0.0 0.0 . 6.6 12.8 12.7 8.7 .Iceland 58.8 65.5 72.0 73.3 76.2 1.5 0.0 0.0 1.7 1.6 39.7 34.5 28.0 25.0 22.2Israel 89.0 90.9 91.9 92.9 93.6 0.00 0.00 0.00 0.00 0.02 11.0 9.1 8.1 7.1 6.4Jalisco (Mexico) 30.1 28.3 29.5 34.2 40.4 0.0 0.0 0.0 0.0 0.0 69.9 71.7 70.5 65.8 59.6Japan 96.6 96.6 96.8 96.7 96.9 0.04 0.05 0.05 0.06 0.04 3.4 3.4 3.2 3.3 3.1Rep. of Korea 77.0 77.7 78.4 80.2 81.0 0.0 0.0 0.0 0.0 0.0 23.0 22.3 21.6 19.8 19.0Luxembourg 100 100 100 99.2 99.0 0.00 0.00 0.00 0.41 0.34 0.00 0.00 0.00 0.41 0.68Malaysia 89.2 90.1 90.3 89.9 89.8 1.4 1.2 1.0 1.0 1.0 9.4 8.7 8.6 9.1 9.2Morelos (Mexico) . . . 40.6 43.2 . . . 0.0 0.0 . . . 59.4 56.8Netherlands 72.2 73.4 74.7 76.0 77.6 2.1 2.1 2.3 2.2 2.4 25.7 24.5 23.0 21.7 20.1New Zealand 43.3 45.9 45.5 48.1 48.1 14.8 15.8 16.0 15.9 15.6 41.9 38.3 38.4 36.0 36.3Norway 82.9 83.2 80.5 80.7 83.4 0.2 0.5 0.4 0.3 0.3 16.9 16.2 19.1 19.0 16.3Philippines 85.5 87.9 94.5 87.3 93.3 0.0 0.0 0.0 0.0 0.0 14.5 12.1 5.5 12.7 6.7Poland 92.8 92.9 92.8 92.8 93.1 0.0 0.0 0.0 0.0 0.0 7.2 7.1 7.2 7.2 6.9Romania . 81.9 80.6 81.8 82.8 . 0.0 0.0 0.0 0.0 . 18.1 19.4 18.2 17.2Russia 91.9 91.5 91.0 . 91.0 0.0 0.0 0.0 . 0.0 8.1 8.5 9.0 . 9.0Scotland 77.4 77.8 78.9 80.6 82.3 2.2 2.1 1.7 1.8 2.2 20.4 20.1 19.3 17.5 15.4Spain 88.6 90.6 90.1 89.4 90.6 0.0 0.0 0.2 0.1 0.3 11.4 9.4 9.7 10.5 9.2Sweden 74.6 75.8 75.5 73.1 73.5 2.9 3.1 2.6 2.8 2.8 22.4 21.1 21.9 24.1 23.8Taiwan 93.5 93.0 92.4 91.5 90.7 0.0 0.0 0.0 0.0 0.0 6.5 7.0 7.6 8.5 9.3Thailand 93.2 93.9 95.8 94.5 90.5 0.0 0.0 0.0 0.0 0.0 6.8 6.1 4.2 5.5 9.5Turkey 88.2 87.9 88.7 88.1 87.4 0.0 0.0 0.0 0.0 0.0 11.8 12.1 11.3 11.9 12.5UK^ 73.8 76.3 78.6 78.9 81.0 2.2 2.1 2.0 2.0 2.1 24.0 21.6 19.4 19.1 16.9United States 91.6 91.8 91.9 92.0 92.0 0.6 0.7 0.7 0.9 1.0 7.8 7.6 7.3 7.1 7.0Uruguay 92.3 92.3 92.6 90.6 91.1 0.0 0.0 0.0 0.0 0.0 7.7 7.7 7.4 9.4 8.9

6ii Percent distribution of prevalent dialysis patients, by modality, 2008 dii

Percent distribution of prevalent dialysis patients, by modality & year

In Hong Kong, four of five prevalent dialysis patients were treated with CAPD/CCPD in 2008. More than half of prevalent dialysis patients in Jalisco (Mexico) and Morelos (Mexico) use this therapy, as do 36.3 percent of those treated in New Zealand. Hemodialysis remains the most common mode of therapy worldwide; in New Zealand and Australia, however, 15.6 and 9.4 percent of patients, respectively, use home hemodialysis.

InInII

Rate per million population

0 150 300 450 600

Romania

Russia

Morelos (Mexico)

Thailand

Bosnia/Herzegov.

Malaysia

Turkey

Argentina

Chile

Greece

Rep. of Korea

Croatia

Poland

Uruguay

Hungary*

Denmark

New Zealand

Iceland

Australia

UK^

Israel

Scotland

Jalisco (Mexico)

Hong Kong

Canada

Finland

Belgium, Dutch sp.

Belgium, French sp.

Austria

Netherlands

France

Sweden

Spain

United States

Norway 2003 2004 2005 2006 2007 2008

Argentina . . . . . 132Australia 300 312 322 333 339 332Austria 447 413 428 439 457 465Belgium, Dutch speaking 391 402 405 425 443 459Belgium, French speaking 377 393 410 431 450 465Bosnia & Herzegovina 27 32 33 32 32 40Canada 368 381 393 408 427 442Chile 152 156 157 165 175 189Croatia 134 154 166 188 205 231Denmark 288 297 267 274 286 300Finland 391 409 418 434 445 450France . . 390 409 461 481Greece 162 170 182 191 200 212Hong Kong 314 361 387 410 420 442Hungary 195 211 215 240 273 .Iceland 242 247 276 313 316 321Israel 297 313 337 358 372 393Jalisco (Mexico) . . 315 352 399 436Rep. of Korea 177 183 188 196 202 213Malaysia 60 62 64 65 64 62Morelos (Mexico) . . . . 42 34Netherlands 358 377 397 419 447 478New Zealand 291 299 300 298 304 301Norway 489 513 525 536 551 572Poland 156 176 194 209 233 242Romania . . 15 20 22 29Russia 22 23 25 29 . 33Scotland 345 351 361 367 382 401Spain . 522 386 445 453 505Sweden 411 430 439 453 467 484Thailand 34 25 25 20 57 36Turkey 43 47 21 58 80 109U.K., England, Wales & N Ireland . 286 271 288 340 361United States 444 465 486 507 526 545Uruguay 134 151 132 210 235 256

Reported prevalent rates of functioning grafts are greatest in Norway, the United States, and Spain, at 572, 545, and 505 per million population in 2008. Countries and regions reporting rates above 400 per million include Austria, Belgium (both French- and Dutch-speaking), Canada, Finland, France, Hong Kong, Jalisco (Mexico), the Netherlands, Scotland, and Sweden. Morelos (Mexico), Romania, Russia, and Thailand report rates below 40 per million population.

RRRRRRRRRRRR

esrd

transplantation

7ii Prevalent rates offunctioning grafts, 2008 eii

Prevalent rates of functioning grafts,by year (per million population)

Rate per million population

0 25 50 75

Bangladesh

Malaysia

Thailand

Russia

Philippines

Romania

Bosnia/Herzegov.

Hong KongLuxembourg

Iceland

Chile

Turkey

Brazil

Poland

Rep. of Korea

Greece

Argentina

Finland

Hungary*

New Zealand

Czech Republic

Belgium, French sp.

Israel

Denmark

Canada

Uruguay

Belgium, Dutch sp.

Australia

UK^

Austria

Scotland

Morelos (Mexico)

France

Sweden

Netherlands

Spain

Jalisco (Mexico)

United States

Norway 2003 2004 2005 2006 2007 2008

Argentina . . 19.1 21.7 23.0 25.1Australia 27.3 32.3 30.6 31.1 29.3 38.0Austria 43.6 43.6 45.9 47.9 43.7 39.5Bangladesh 0.4 0.3 0.4 0.2 0.5 0.5Belgium, Dutch speaking 37.3 31.5 28.4 39.7 42.3 37.7Belgium, French speaking 36.5 29.8 37.6 39.1 40.8 32.4Bosnia & Herzegovina 6.5 7.6 11.5 6.8 8.4 9.1Brazil 17.9 18.8 18.4 17.8 18.5 20.2Canada 33.4 32.1 32.7 36.8 37.8 36.4Chile 19.8 16.9 17.2 18.5 17.1 16.8Czech Republic 40.4 41.6 38.0 41.6 38.0 31.9Denmark 32.7 34.8 32.7 33.3 31.2 35.7Finland 31.3 37.1 31.8 39.7 32.3 27.9France . . 36.6 38.9 45.6 45.2Greece 21.7 19.1 23.7 22.2 21.5 23.6Hong Kong 7.5 7.4 8.6 9.6 9.5 11.3Hungary 30.0 29.2 31.5 31.1 28.2 .Iceland 3.5 10.3 33.7 26.3 22.5 15.8Israel 36.8 37.0 43.4 43.2 37.7 33.7Jalisco (Mexico) 46.6 56.5 55.7 52.2 59.3 54.3Rep. of Korea 16.5 17.4 15.5 18.8 18.5 22.7Luxembourg 37.5 37.2 51.1 39.1 44.7 14.6Malaysia 6.4 7.4 6.2 5.3 3.7 3.3Morelos (Mexico) . . . . 54.6 44.5Netherlands 38.6 41.8 43.1 41.0 50.8 46.9New Zealand 27.7 25.7 22.5 21.5 29.1 28.6Norway 52.8 57.7 49.5 45.5 55.2 58.3Philippines 4.9 5.6 7.5 8.0 11.8 7.1Poland 27.0 28.9 29.3 24.5 18.3 21.3Romania . . 4.7 5.3 2.8 7.2Russia 2.3 2.0 2.8 2.9 . 5.5Scotland 30.3 26.6 29.2 26.6 37.1 41.6Spain . 59.0 67.3 48.2 47.3 48.3Sweden 39.0 41.7 43.2 40.3 42.1 45.6Thailand 5.7 4.3 . . 5.9 5.4Turkey 8.0 9.2 4.5 11.6 18.6 18.1U.K., England, Wales & N Ireland . 33.8 29.9 33.9 35.5 38.5United States 55.4 57.9 59.0 60.5 58.2 57.2Uruguay 20.9 31.8 35.4 42.8 28.9 37.5

Norway, the United States, and Jalisco (Mexico) reported transplant rates of 58.3, 57.2, and 54.3 per million population in 2008. Rates are less than 10 per million, in contrast, in Bangladesh, Bosnia and Herzegovina, Malaysia, the Philip-pines, Romania, Russia, and Thailand.

NNNNNN

Data presented only for those countries from which relevant information was available; “.” signifies data not reported. All rates are unad-justed. ̂ UK: England, Wales, & Northern Ireland (Scotland data reported separately). *Latest data for Hungary are 2007. Data for France include 13 regions in 2005, 15 regions in 2006, & 18 regions in 2007 & 20 regions 2008.

8ii Transplantrates, 2008 fii

Transplant rates, by year(per million population)

All

Rate

per

mill

ion

popu

latio

n

0

100

200

300

400

500

United States (USRDS): (mean age, 60.0)Taiwan (TSN): (63.7)Japan (JSDT): (67.2)

20-44

45-64

90 92 94 96 98 00 02 04 06 080

500

1,000

1,500

2,000

2,500

90 92 94 96 98 00 02 04 06 08

65+

Male

90 92 94 96 98 00 02 04 06 08

Rate

per

mill

ion

popu

latio

n

0

100

200

300

400

500United StatesTaiwanJapan

90 92 94 96 98 00 02 04 06 08

Female

Diabetes

90 94 98 02 06

Rate

per

mill

ion

popu

latio

n

0

50

100

150

200United StatesTaiwanJapan

90 94 98 02 06

Glomerulonephritis

90 94 98 02 06

Other

2010 usrds annual data report

volumetwoesrdpage394

12international comparisonsincident esrd rates in asian & indigenous populations

129ii Unadjusted incident rates of ESRD in Asian populations, by age

1211ii Unadjusted incident rates of ESRD in Asian populations, by primary diagnosis

1210ii Unadjusted incident rates of ESRD in Asian populations, by gender

These figures illustrate trends in ESRD incidence in Asian populations from Taiwan, Japan, and the U.S. Because data are unadjusted, comparisons between countries must be made cau-tiously. In the future we will develop a common adjustment method to reflect the uniqueness of these countries as well as of the populations within the U.S.

The high rates of ESRD incidence long noted in Taiwan peaked in 2005, and have since declined about 11 per-cent. For patients age 20–44, rates in the U.S. Asian population are 42 per-cent higher than in the Taiwanese population; rates in Japan, in contrast, are generally only half as high as those found in U.S. Asians, and have been falling — an important observation, given the country’s growing challeng-es with diabetes and obesity. Among patients age 65 and older, rates differ dramatically — from 803 per million population in Japan to more than 1,900 in Taiwan.

Rates by primary diagnosis show that ESRD due to glomerulonephritis continues to decline among Asian pa-tients, possibly reflecting their near uni-versal treatment with ACEs/ARBs. It is important to recognize that glomerular diseases are the second leading cause of ESRD in most Asian patients (hyperten-sion holds that rank for white patients in the U.S.). Rates of ESRD due to diabe-tes, in contrast, appear to be rising in all three Asian populations, an issue of great public health concern. Public health surveillance data on awareness, treatment, and control of kidney dis-ease risk factors are needed to deter-mine if progress is being made in blood pressure control, glycemic control, and the control of salt intake and weight. ∏ Figures 12.9–11; see page 488 for analytical methods. Incident dialysis patients.

All

Rate

per

mill

ion

popu

latio

n

0

100

200

300

400

50020-44

45-64

90 92 94 96 98 00 02 04 06 080

500

1,000

1,500

2,000

2,500

90 92 94 96 98 00 02 04 06 08

65+

U.S. Nat. Amer. (USRDS; mean age, 57.7)Australia Aboriginal (ANZ data; 60.5)

New Zealand Maori & Pacific People (ANZ data; 55.6)

Canada Aboriginal (CORR data; 63.3)

Male

90 92 94 96 98 00 02 04 06 08

Rate

per

mill

ion

popu

latio

n

0

100

200

300

400

500

90 92 94 96 98 00 02 04 06 08

FemaleU.S. Native AmericanAustralia Aboriginal

New Zealand Maori & Pacific People

Canada Aboriginal

Diabetes

90 94 98 02 06

Rate

per

mill

ion

popu

latio

n

0

100

200

300

400

90 94 98 02 06

New Zealand Maori &Pacific People

U.S. Native AmericanAustralia Aboriginal

Canada Aboriginal

Glomerulonephritis

90 94 98 02 06

Other

�������

��12ii Unadjusted incident rates of ESRD in indigenous populations, by age

��14ii Unadjusted incident rates of ESRD in indigenous populations, by primary diagnosis

��13ii Unadjusted incident rates of ESRD in indigenous populations, by gender

Native populations in Canada, Aus-tralia, New Zealand, and the U.S. face considerable public health challeng-es — obesity, diabetes, and hyperten-sion, limited access to health care, and economic stresses related to high rates of unemployment and poverty. Each country has attempted to increase health care access, but programs have often been difficult to sustain. In the U.S., the Indian Health Service has fo-cused on diabetes and preventive care. Other countries have tried similar ap-proaches with some success, but face limited budgets.

Direct rate comparisons are not pos-sible without knowing the availability of CKD care and dialysis services. In general, however, reported ESRD inci-dence among indigenous populations in Canada and the U.S. has been falling for those age 45 and older. In the Aus-tralian Aboriginal population age 45 and older, in contrast, rates have been rising during the last 20 years; this is also true among New Zealand Maori and Pacific people age 65 and older.

Around the world there has been increasing discussion of moving more dialysis delivery outside the hospital setting, which may increase access. Perhaps more importantly, however, preventive care to reduce the burden of diabetes, hypertension, and obesity is needed across all populations. Many countries have developed early detec-tion and screening programs for diabe-tes in the native populations, which car-ry a disproportionate risk of the disease.

While diabetes is the dominant cause of ESRD in these native popula-tions, the trends vary. Rates among Native Americans in the U.S. have been falling since the late 1990s; those of Ca-nadian Aboriginal populations have leveled off and show signs of falling in the last two years. Rates in Austra-lia and New Zealand, in contrast, have been rising. ������ ������������������������������ ��������������Incident dialysis patients.

NN

esrd

summary

Incident rates of reported ESRD in 2008 were greatest in Morelos (Mexico), at 557 per million population, followed by Jalisco (Mexico), Taiwan, the United States, and Japan (dialysis only) at 400, 384, 362, and 288, respectively.

In 2008, diabetes was the primary cause of ESRD in 59.8, 55.8, and 54.6 percent of new patients in Morelos (Mexico), Malaysia, and Jalisco (Mexico).

Taiwan and Japan (dialysis only) continue to report the greatest prevalent rates of ESRD, at 2,311 and 2,126 per million population, respectively, in 2008.

In Hong Kong, four of five prevalent dialysis patients were treated with CAPD/CCPD in 2008.

Reported prevalent rates of functioning grafts are greatest in Norway, the United States, and Spain, at 572, 545, and 505 per million population in 2008.

The high rates of ESRD incidence long noted in Taiwan appear to have peaked in 2005, and have since declined about 11 percent.

Rates of reported ESRD due to glomerulonephritis continue to decline among Asian patients, possibly reflecting near universal treatment with ACEs/ARBs.

Rates of reported ESRD in the Australian and New Zealand aboriginal populations have been rising since 1990.