Global challenges posed by the growth of end-stage renal disease

Abstract

Profound challenges confront societies worldwide due to the growth of end-stage renal disease (ESRD). Meeting these challenges requires a sober assessment of how overall global health trends affect ESRD, coupled with an understanding of how progress in the care of ESRD patients is most appropriately measured and monitored. For many affluent countries, incident ESRD rates have stabilized since about the middle of the last decade. For example, the number of new cases in the USA has remained stable at approximately 110,000 per year during this period, while in Japan, growth in annual incident counts appears to have stabilized as of 2012. However, incidence rates rose for many developing countries. An immense "renal replacement therapy (RRT) gap," the difference between the number of people receiving RRT and the number needing it, was recently described, highlighting the magnitude of the difficulties these countries face as they continue to develop. To guide efforts to improve care, broad goals should be established by the worldwide renal health care community. For countries without universal dialysis access, expansion of RRT accessibility should be the first target in order to reduce the RRT gap; for countries that have moved beyond this stage, the goals should include reductions in ESRD incidence rates; all-cause, cardiovascular, and infection-related death rates; and cardiovascular-and infection-related hospitalizations. To inform judgements about progress in this area, measures beyond the traditional standardized mortality ratio are needed. Carefully determining trends over time within a given country, such as is done by the World Health Organization, might prove to be a more useful way to determine progress in combating ESRD and its complications.

Symptoms and quality of life from patients undergoing hemodialysis in Switzerland

“…According to the Global Burden of Disease Study, [2] CKD ranked 18 th on the list of causes of global deaths in 2010 (16.3 per 100,000 deaths annually) and has now become a serious public health issue. [3] Moreover, patients with CKD inevitably progress, over the medium to long term, towards end-stage renal disease (ESRD), which necessitates long-term renal replacement therapy, the most common of which is hemodialysis (HD). [4] Switzerland has not been spared from the phenomenon: 350,000 of its inhabitants live with the disease, 30,000 of which with a severe form of the disease.…”

Assessment of quality of life in patients undergoing hemodialysis using WHOQOL-BREF questionnaire: a multicenter study

“…4 In developing countries, such as Nepal, limited access to RRT, physical inaccessibility to health facilities, economic and cultural barriers with respect to transplantation, high prevalence of communicable diseases, and lack of infrastructure pose challenges in effective management of CKD. 5 Patients with CKD on MHD have to bear significant physical, psychological, and economic challenges. 6,7 Patients, along with their families, must change their lifestyles to adapt to the rigor and frequencies of hemodialysis sessions, which can be up to thrice a week.…”

Predictors of long-term survival of hemodialysis patients in Hamadan province, west of Iran

“…In recent decade, many of developed countries had a stable or decreasing trend in incidence rate of ESRD. However, as controversy in some countries like Iran and other developing countries a rising trend in the prevalence of diabetes mellitus and hypertension as the most leading causes of ESRD are detected, which leads to increasing proportion of hemodialysis (HD) centers (3)(4)(5). In Iran, HD represents the main way of RRT for ESRD patients (6).…”