Demographics of the End-Stage Renal Disease Patient

Introduction

End-stage kidney disease (ESKD) constitutes an ever-increasing threat to public health. Since the publication of the last edition of this book in 2015, complex trends have continued to evolve in the epidemiology of ESKD and maintenance dialysis. In this chapter, we highlight how incidence rates of treated ESKD have increased globally, a phenomenon that will almost certainly continue as low- and middle-income countries undergo economic growth and experience improvements in access to health care, including dialysis. In many developing countries, the challenge posed by the growth of the incident ESKD population will therefore be to overcome the barriers hindering the creation of an adequate dialysis infrastructure. For many high-income countries, the overall growth in the population receiving dialysis has been fueled mainly by an increase in prevalent patients receiving maintenance dialysis, although incidence rates have also continued to increase in many such countries. Prevalent dialysis patients in the United States, for example, are now living substantially longer than they did a decade ago. In developed countries, then, the struggle will be to provide healthcare for ever-aging populations with ESKD and multiple comorbid conditions. In developing and developed countries, policy makers and public health officials face major challenges in confronting the growth of ESKD.

In this chapter, we review demographic data from the United States and other counties to provide background for subsequent chapters. Most U.S. data are derived from the United States Renal Data System (USRDS) ( www.usrds.org ), which also collects data from some other countries that contribute to this registry.