ArticlesWorldwide access to treatment for end-stage kidney disease: a systematic review
Introduction
Renal replacement therapy (RRT), through either dialysis or renal transplantation, is a lifesaving yet high-cost treatment for people with end-stage kidney disease. It has been available in high-income countries for more than 50 years, with rapid growth in the number of people treated during this period. The use of dialysis to treat end-stage kidney disease varies substantially between regions, probably because of differences in population demographics, prevalence of end-stage kidney disease, and factors affecting access to and provision of RRT.1, 2
The prevalence of end-stage kidney disease could rise sharply over the next few decades, driven by population ageing and an increasing prevalence of diabetes and hypertension.1, 3, 4 The demographic transition driving this rise is expected to occur predominantly in developing rather than developed countries, challenging the economic capacity of many countries to provide RRT to an increasing number of people with end-stage kidney disease.5, 6, 7
To develop service provision strategies for people with end-stage kidney disease, the burden of the disorder and availability of RRT need to be known, and projections of future demand for RRT made. In this systematic review, we quantified the worldwide burden of end-stage kidney disease and use of RRT, and estimated future trends.
Section snippets
Data sources
We systematically searched the literature describing the prevalence of end-stage kidney disease in countries around the world according to the Meta-analysis of Observational Studies in Epidemiology group consensus statement8 for conduct of such studies. We defined end-stage kidney disease as kidney failure needing continuing maintenance dialysis or a kidney transplant for survival. We defined RRT as any form of maintenance dialysis (either haemodialysis or peritoneal dialysis, excluding
Results
With our search strategy, we identified 3611 articles, of which 68 were selected for full text review. We also identified nine potential articles from other sources, such as conference proceedings, input from the experts in the discipline, and Google and Google Scholar searches that used individual country names. We included 18 articles in this systematic review after full text review of these 77 reports (figure 1). These included 13 renal registries, of which four reported regional data for 42
Discussion
In this systematic review, we used the best available data to calculate the number of people receiving RRT in 2010, noting that about 2·618 million people received this life-sustaining treatment worldwide. Additionally, our findings suggest that, at best, only half or less of all people needing RRT worldwide had access to it in 2010, meaning at least 2·284 million people might have died prematurely because they did not have access to the treatment in 2010. Most of this burden of preventable
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Contributed equally