Epidemiology of end-stage renal disease: International comparisons of renal replacement therapy

Renal replacement therapy (RRT) remains the most important tool for all pat ients with end-stage renal disease (ESRD) in the world. Patients are usuall y listed in the national renal registries which report demographic data, in cidence, prevalence and outcome. Differences in acceptance of the RRT, pati ent demographics, socioeconomic burdens and national health care legislatur e influence the validity of international comparisons of ESRD therapy. For this reason, the renal registries decided to organize an international coll aborative study group, the International Federation of Renal Registries (IF RR), for improving the standardization of renal databases and for promoting international collaborative studies. Demographic data from renal registrie s in 1996 showed that approximately 1,000,000 of ESRD patients received RRT throughout the world and approximately 200,000 new patients started RRT. T he different distribution of patients in the world is strongly influenced b y the level of gross domestic product (GDP), since economical crisis may in fluence the number of patients starting RRT. The reported incidence and pre valence values of ESRD patients in RRT from the renal registries show these differences. The mortality rate of these patients is notably influenced by the percentage of enrolled diabetic RRT patients. Therefore, important dif ferences in outcome of RRT depend on the underlying disease which is a dete rminant factor of prognosis. Other factors responsible for the outcome are represented by dialysis dose, type of membrane, erythropoietin and nutritio nal status.