This document provides epidemiological data on end-stage renal disease (ESRD) populations worldwide. It includes comparisons of ESRD incidence and prevalence internationally and variations by geographic region. Demographic characteristics of ESRD patients such as age, sex, race, and comorbidities like diabetes and cardiovascular disease are presented. Clinical parameters including hemoglobin levels, dialysis adequacy, mineral bone disorders, and vaccination rates are also reported and compared across different countries. High-quality care for ESRD patients should focus on reducing mortality and morbidity by regularly evaluating these medical aspects and ensuring treatment of conditions like anemia, serum potassium, cardiovascular disease, nutrition, diabetes, and hypertension.

2. Hemodialysis Patient Care

3. Scheme

4. Epidemiology of ESRD population

5. Comparison of unadjusted ESRD incidence worldwide. USRDS 2013
All rates are unadjusted. Data from Japan are dialysis only.

6. Comparison of unadjusted ESRD prevalence worldwide. USRDS 2013
All rates are unadjusted. Data from Japan are dialysis only.

7. Geographic variations in the incidence of ESRD (per million population), 2011
??
Data presented only for countries from which relevant information was available. All rates unadjusted. Latest data for
Taiwan are for 2010. Data for France include 25 regions. Data for Belgium do not include patients younger than 20.

12. Incidence of ESRD, 2011
GULF ?
BAHRAIN ?
Middle East?
Data presented only for countries from which relevant information was available; “.” signifies data not reported. All rates
unadjusted. ^UK: England, Wales, & Northern Ireland (Scotland data reported separately). Data for Belgium do not include
patients younger than 20. *Latest data for Taiwan are from 2010. Incident data for Croatia start at day 91, 2011. Data for France
include 25 regions in 2011. All rates are unadjusted.

13. Prevalence of ESRD, 2011

14. Percentage of incident patients with ESRD due to diabetes, 2011
Data presented only for countries from which relevant information was available. All rates unadjusted. ^UK: England, Wales, &
Northern Ireland (Scotland data reported separately). *Latest data for Taiwan are from 2010. ^^ Czech Republic: Data on
incident ESRD due to diabetes is an estimate. Data for France include 25 regions in 2011. .

15. Percent distribution of prevalent dialysis patients, by modality, 2011
Data presented only for countries from which relevant information was available; “.” signifies data not reported. All rates
unadjusted. ^UK: England, Wales, & Northern Ireland (Scotland data reported separately). **Data for Belgium do not include
patients younger than 20. *Latest data for Taiwan are from 2010. Data for France include 25 regions in 2011.

16. Patient counts, by modality
Incident & December point prevalent ESRD patients. CMS Annual Facility Survey.

17. Incident & prevalent patient counts (USRDS), by modality
Incident & December 31 point prevalent ESRD patients; peritoneal dialysis consists of CAPD & CCPD.

18. Adjusted prevalent rates of ESRD & annual percent change
December 31 point prevalent ESRD patients. Adj: age/gender/race; ref: 2010 ESRD patients.

19. Incident counts & adjusted rates of ESRD, by primary diagnosis
Incident ESRD patients.
Adj: age/gender/race; ref: 2010 ESRD patients.

20. Prevalence of ESRD
December 31 point prevalent ESRD patients. Adj: age/gender/race; ref: 2010 ESRD patients.

21. Prevalent counts & adjusted rates of ESRD, by age
December 31 point prevalent ESRD patients. Adj: gender/race; ref: 2010 ESRD patients.

22. DOPPs
Dialysis Outcomes and Practice Patterns Study
Australia, Bahrain, Belgium, Canada, China, France, Germany, Italy,
Japan, Kuwait, New Zealand, Oman, Qatar, Russia, Saudi Arabia,
Spain, Sweden, Turkey, the United Arab Emirates, the United
Kingdom, and the United States

23. Demographics of ESRD population

24. DOPPS 4 (2011) Age, by country
Median 67.74 y
The top and bottom of the boxes above indicate the 25th and 75th percentiles of the distribution. The horizontal line
within the box indicates the median (50th percentile), and the diamond indicates the mean. Vertical lines extend to the
5th and 95th percentiles.

25. DOPPS 4 (2011) Body-mass index, by country
Median 25.3

26. DOPPS 4 (2011) Male sex, by country
Male 60%

27. DOPPS 4 (2011) Race/ethnicity, by country

28. Anemia

29. DOPPS 4 (2011) Hemoglobin, by country
Median 11.2
Excludes patients with Hgb<4 g/dl or Hgb>18 g/dl
The top and bottom of the boxes above indicate the 25th and 75th percentiles of the distribution. The horizontal line within
the box indicates the median (50th percentile), and the diamond indicates the mean. Vertical lines extend to the 5th and 95th
percentiles.

30. DOPPS 4 (2011) Darbepoetin use, by country
Mean 40%
Prescription in previous three months, among patients prescribed any ESA

31. DOPPS 4 (2011) Iron use (IV or oral), by country
Medications reported as prescribed in previous three months, among all patients
Mean 73.8%

32. DOPPS 4 (2011) Serum ferritin, by country
Median 406
The top and bottom of the boxes above indicate the 25th and 75th percentiles of the distribution. The
horizontal line within the box indicates the median (50th percentile), and the diamond indicates the
mean. Vertical lines extend to the 5th and 95th percentiles.

33. Period prevalent hemodialysis patients.

34. Mean hemoglobin at initiation, by pre-ESRD ESA treatment
Incident ESRD patients.

35. Hemodialysis
Incident hemodialysis patients. (Each month includes patients with a claim for hemodialysis.)

36. Cardiovascular Disease

37. DOPPS 4 (2011) Coronary artery disease, by country
Mean 33.5%

38. DOPPS 4 (2011) Cerebrovascular disease, by country
Mean 14.5%

39. DOPPS 4 (2011) Diabetes, by country
Mean 42%

40. DOPPS 4 (2011) Diabetes as Cause of ESRD, by country
Mean 34.9%

41. DOPPS 4 (2011) Hypertension, by country
Mean 85%

42. DOPPS 4 (2011) Peripheral vascular disease, by country
Mean 28.6%

43. USRDS 2013
Cardiovascular Disease in ESRD population.

44. Causes of death in prevalent dialysis patients, 2009-2011
Incident & prevalent dialysis patients, 2009–2011.
42%

45. Survival of patients with cardiovascular diagnoses & procedures, by modality, 2009–2011
January 1 point prevalent ESRD patients, 2009, with a first cardiovascular diagnosis or procedure in 2009–2011.

46. Rates of a CHF diagnosis in ESRD patients
Point prevalent ESRD patients on January 1 of each year: unadjusted.

47. Rates of an AMI event in ESRD patients
Point prevalent ESRD patients on January 1 of each year: unadjusted.

48. Percent of incident dialysis patients receiving first echocardiograms, 2011
Incident dialysis patients, 2011.

49. Hemodialysis Adequacy

50. DOPPS 4 (2011) Serum creatinine, by country
Median 8mg/dl

51. DOPPS 4 (2011) Prescribed blood flow rate, by country
Median 330
Replenishment sample patients only The top and bottom of the boxes above indicate the 25th and 75th
percentiles of the distribution. The horizontal line within the box indicates the median (50th percentile), and the
diamond indicates the mean. Vertical lines extend to the 5th and 95th percentiles.

52. DOPPS 4 (2011) Single-pool Kt/V, by country
Median 1.56

53. Mineral Bone Disorders in ESRD

54. Risk of all-cause mortality associated with combinations of baseline
serum phosphorus and calcium categories by PTH level (from DOPPS)
Tentori F, et al. AJKD 52: 519, 2008

55. Predialysis Multivariable-adjusted log hazards (solid lines) and 95% CI (dashed lines) of all-cause
mortality associated with fixed baseline levels of serum calcium concentration in Cox
models
Kovesdy C P et al. CJASN 2010;5:468-476
©2010 by American Society of Nephrology
Adjusted:
• Age
• Race
• CrCl
• DM
• CVD
• P
• BMI
• Smoking
• PO
binders
• Calcitriol
• eGFR
• HCO3
• PO4
• Alk.
Phosp.
• Hb
• WBC

56. N = 16173
over 18 years

57. N = 16173
over 18 years

62. DOPPS 4 (2011) Total calcium, by country
Median 8.9

63. DOPPS 4 (2011) Serum phosphorus, by country
5.5
Median 4.36
3.5

64. DOPPS 4 (2011) Serum PTH, by country
300
Mean 240
150

65. Percent of patients prescribed any phosphate binder at end of study month,
among all patients
Mean 80%
DOPPS 4 (2011) Phosphate binder use, by country

66. DOPPS 4 (2011) Calcium-based phosphate binder, by country
Mean 38%

67. DOPPS 4 (2011) Vitamin D use (IV or oral), by country
Mean 70%

68. DOPPS 4 (2011) Serum albumin, by country
Excludes patients with albumin <1 g/dl or albumin >7 g/dl
Median 3.7

69. Vaccination rates (percent), by age, race/ethnicity, & modality
ESRD patients initiating treatment at least 90 days before tracking period: September 1–December 31 for influenza, a two-year
period for pneumococcal pneumonia, yearly for hepatitis B; patients alive on the period’s last day & vaccinations tracked during the
period.

70. Quality indicators: percentage of patients meeting clinical &
preventive care guidelines

71. Other Parameters for Care:
• Monthly Serum K+.
• Diabetic treatment.
• HTN treatment.
• Lipid profile.
• Annual Cardiac evaluation.
• Annual Dental care.
• Medications review.
• Regular meeting and interaction.
• Diet Review.
• Filter Clotting.

72. Conclusion:
ESRD patient would require high quality care to reduce the
Mortality and Morbidity.
Different aspects of medical care if regularly evaluated.
Vascular Access.
• Anemia.
• S. K.
• CVD.
• Nutrition.
• DM
• Vaccination.
• HTN
• Hyperlipidemia
• Mineral Bone Disorders.