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Twelve: International comparisons

We are pleased this year to present data from 44 regions and countries, again offering a worldwide picture of ESRD and the ways in which practitioners choose to treat it. This year we update our figures comparing the incidence and prevalence of ESRD around the world.

As reported in 2005, Taiwan (whose data include only dialysis patients), the United States, and Jalisco (Mexico) again report the highest rates of incident ESRD at 418, 363, and 346 per million population, respectively. Iceland, Iran, Romania, the Philippines, and Finland, in contrast, report rates of 59–84, while reported rates are lowest in Bangladesh, Russia, and Pakistan, at 9, 28, and 29 per million population, respectively.

Diabetes as a primary cause of ESRD accounts for a large proportion of incident ESRD patients. Malaysia, for example, reports a 2006 incident rate of 119 per million population—and nearly 58 percent of these patients have diabetes. Jalisco, the United States, Japan, Taiwan, the Republic of Korea, New Zealand, Hong Kong, and Israel all report rates of diabetes exceeding 40 percent.

Prevalent rates for 2006 were highest in Taiwan and Japan (dialysis only), at 2,226 and 1,956 per million population, respectively, followed by the United States and Germany at 1,641, and 1,114. And reported rates for Jalisco have more than doubled in a span of four years, increasing from 394 in 2003 to 929 per million in 2006.

Hemodialysis is the most common mode of dialysis therapy world-wide, evidenced by data showing that, in over 60 percent of reporting countries, at least 80 percent of patients are on this mode of therapy. This is not the case, however, in countries such as Hong Kong and Jalisco, where peritoneal dialysis is provided to 81 and 71 percent of patients, respectively. And home hemodialysis therapy is provided to nearly 10 percent of patients in Australia and to 16 percent of patients in New Zealand.

Renal transplant rates are many times a reflection not only of a country’s health-care system, but of cultural diversities as well. Transplant rates, for example, are less than 10 per million population in countries such as Hong Kong, the Philippines, Romania, and Malaysia, in contrast to rates exceeding 60 per million in Spain and the United States. Rates of functioning grafts reach 506 and 537 per million, respectively, in the United States and Norway, but are less than 30 per million in Russia, Thailand, Romania, and Bangladesh.

We invite all renal registries to send their data, using the form provided on page 243. You may return it to us by email or fax: usrds@usrds.org, and 1.612.347.5878. We wish to thank all participating registries for their willingness to provide data on their ESRD programs and help us give a perspective on patients with ESRD worldwide.

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figure 12.1a, 12.1b Comparison of ESRD incidence & prevalence worldwide
all rates are unadjusted. Data from Israel, Japan, & Taiwan are dialysis only. Incident data for Jalisco not shown due to high year-to-year variability.

figure 12.2 & table 12.a Incident rates of reported ESRD in are greatest in Taiwan (dialysis only), at 418 per million population in 2006, followed by the United States, Jalisco (Mexico), Shanghai, and Japan. Rates of 100 per million population or lower are reported by Bangladesh, Russia, Pakistan, Iceland, Iran, Romania, the Philippines, Finland, and Norway. It is important to note the distinction between the incidence of treatment, guided by available funding, and the incidence of a disease itself. An affluent nation may allow elderly patients and those with diabetes to receive hemodialysis, while developing nations may restrict this treatment to younger, healthier patients.

figure 12.3 & table 12.b Diabetes was the primary cause of ESRD in 58 percent of new patients in Malaysia in 2006, and 50 percent of those in Jalisco (Mexico). In a majority of reporting countries, 20–44 percent of new patients have this primary diagnosis. Countries with the lowest reported rates of ESRD due to diabetes include Romania, Russia, the Netherlands, Norway, Uruguay, and the United Kingdom (England, Wales, and Northern Ireland), each with 12–19 percent.

figure 12.4 & table 12.c Taiwan (dialysis only) continues to report the greatest prevalent rates of ESRD, at 2,226 per million population in 2006. Th e next highest rates are reported by Japan and the United States, at 1,956 and 1,641. Th e lowest rates, of 88 and 92 per million population, are reported by the Philippines and Bangladesh.

figure 12.5 & table 12.dd In Hong Kong, 81 percent of patients were treated with CAPD/CCPD in 2006, the highest reported rate worldwise. Th e therapy is also widely used in Jalisco (Mexico), at 70 percent, and in New Zealand and Iceland, at 39 and 29 percent, respectively. Fewer than 5 percent of patients, in contrast, are treated with peritoneal dialysis in Luxembourg, Bangladesh, Japan, Argentina, Th ailand, and Bosnia and Herzogovina. Reported use of home hemodialysis is great- est in New Zealand and Australia, at 16 and 9.5 percent.

figure 12.6 & table 12.e Reported prevalent rates of functioning graft s are greatest in Norway and the United States, at 537 and 506 per mil- lion population in 2006, respectively. Other countries and regions reporting rates greater than 400 per million population include Spain, Sweden, Austria, Luxembourg, Finland, Belgium (both Dutch- and French-speaking), the Netherlands, and France. Bosnia and Her- zogovina, Russia, Th ailand, and Romania each report rates of 20–32, while Bangladesh reports only 4 functioning graft s per million popu- lation.

figure 12.7 & table 12.f  Spain and the United States each report a trans- plant rate of 60 per million population in 2006. Th e reported rate is less than 10 per million population, in contrast, in Hong Kong, the Philippines, Romania, Malaysia, Russia, Bosnia and Herzogivina, and Bangladesh.

figure 12.8 Incident rates of ESRD per million population, 2006 data presented only for those countries from which relevant information was available. All rates are unadjusted. Data from Argentina, Czech Republic, Israel, Japan, Luxembourg, Shanghai, & Taiwan are dialysis only. Latest data for Canada, Croatia, & Italy are for 2005. Data for France include 15 regions in 2006.

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Captions

figure 12.1 all rates are unadjusted. Data from Israel, Japan, & Taiwan are dialysis only. Incident data for Jalisco not shown due to high year-to-year variability.

all figures & tables data presented only for those countries from which relevant information was available; “.” signifies data not reported. All rates are unadjusted. ^UK: England, Wales, & Northern Ireland (Scotland data reported separately). Data from Argentina, Czech Republic, Israel, Japan, Luxembourg, Shanghai, & Taiwan are dialysis only. Latest data for Canada, Croatia, & Italy are for 2005. Data for France include 13 regions in 2005 & 15 regions in 2006.

all fi gures & tables data presented only for those countries from which relevant information was available; “.” signifi es data not reported. All rates are unadjusted. ^UK: England, Wales, & North- ern Ireland (Scotland data reported separately). Data from Argentina, Czech Republic, Israel, Japan, Luxembourg, Shanghai, & Taiwan are dialysis only. Latest data for Canada, Croatia, & Italy are for 2005. Data for France include 13 regions in 2005 & 15 regions in 2006.

all fi gures & tables data presented only for those countries from which relevant information was available; “.” signifi es data not reported. All rates are unadjusted. ^UK: England, Wales, & North- ern Ireland (Scotland data reported separately). Data from Argentina, Czech Republic, Israel, Japan, Luxembourg, Shanghai, & Taiwan are dialysis only. Latest data for Canada, Croatia, & Italy are for 2005. Data for France include 13 regions in 2005 & 15 regions in 2006.