Current status of dialysis therapy in Korea

Abstract

The number of patients with end-stage renal disease (ESRD) is rising very rapidly as the number of elderly and patients with diabetes increases in Korea. ESRD Registry Committee of the Korean Society of Nephrology (KSN) collected dialysis therapy data in Korea through an online registry program on the KSN website. The status of renal replacement therapy in Korea at the end of 2009 was as follows. First, total number of patients with ESRD was 56,396 (hemodialysis [HD], 37,391; peritoneal dialysis [PD], 7,618; functioning kidney transplant [KT], 11,387). The prevalence of ESRD was 1,113.6 patients per million population (PMP). Proportion of patients undergoing renal replacement therapy was 66.3% with HD, 13.5% with PD, and 20.2% with KT. Second, a total of 8,906 (HD, 6,540; PD, 1,125; KT, 1,241; incidence rate of 175.9 PMP) patients developed ESRD in 2009. Third, the most common primary causes of ESRD were diabetic nephropathy (45.4%), hypertensive nephrosclerosis (18.3%), and chronic glomerulonephritis (11.1%). Fourth, mean urea reduction rate was 67.5% and 73.8% in male and female patients, respectively, undergoing HD. Mean Kt/V was 1.38 in male patients and 1.65 in female patients. Fifth, the overall 5-year survival rate of male patients undergoing dialysis was 65.4% and that of female patients was 67.4%.

Keywords: Kidney failure, chronic; Korea; Peritoneal dialysis; Renal dialysis.

Figure 1

Prevalence and incidence of ESRD in Korea. (A) Numbers of renal replacement therapy patients at the end of each year. (B) New renal replacement therapy patients by year. (C) Three major causes of ESRD. ESRD, end-stage renal disease; HD, hemodialysis; KT, kidney transplant; PD, peritoneal dialysis; CGN, chronic glomerulonephritis; DM, diabetes mellitus; HTN, hypertensive nephrosclerosis.

Figure 2

Renal replacement therapy modalities. (A) Proportion of renal replacement modalities. Annual prevalence and incidence in 2009. (B) Number of hemodialysis centers and hemodialysis machines. (C) Percent distribution of patients undergoing hemodialysis according to the dialysis center classification. (D) Distribution of patients undergoing dialysis based on their life zone in Korea. KT, kidney transplant; PD, peritoneal dialysis; HD, hemodialysis.

Figure 3

Dialysis patient demographics. (A) Age distribution of patients undergoing dialysis according to dialysis modality. (B) Age distribution of patients undergoing dialysis. Note that the peak age has shifted toward an older age. (C) Age distribution of patients undergoing dialysis according to underlying diseases: patients with diabetes mellitus (DM), hypertensive nephrosclerosis (HTN), and glomerulonephritis (GN). Note the difference in peak age between GN and DM. (D) Duration of maintenance hemodialysis and peritoneal dialysis. Percentage of estimated patient numbers by year. (E) Body mass index (BMI) distribution in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). (F) Distribution of mean blood pressure (MBP) in patients undergoing HD and PD. The blood pressure (BP) in patients undergoing HD was higher than that of patients undergoing PD. (G) Systolic and diastolic BP with pulse pressure in patients undergoing HD and PD. Note the difference in pulse pressure between the two groups.

Figure 4

Erythropoietin therapy, hemodialysis (HD) and peritoneal dialysis (PD) therapy characteristics. (A) Changes in hematocrit (%) in patients undergoing dialysis: HD vs. PD. Note the increase in the hematocrit of patients undergoing HD. (B) Percent distribution of erythropoietin (EPO) doses prescribed for patients undergoing HD and PD. (C) Currently using HD membrane and dialysis membrane reuse and percentage of hemodiafiltration (HDF) in private clinics. (D) Distribution of the urea reduction ratio (URR) in patients undergoing HD. Note the difference between males and females. (E) Dialysis adequacy parameters (nPCR and Kt/V) of patients undergoing HD. (F) Dialysis adequacy parameters (Kt/V) for patients with diabetes mellitus (DM) and nonDM who were undergoing HD. (G) Annual changes in dialysis adequacy parameters for patients undergoing HD. (H) Percent distribution of peritoneal dialysis type and doses (2009, n = 2,836). CAPD, continuous ambulatory peritoneal dialysis; APD, automated peritoneal dialysis.

Figure 5

Morbidity, causes of death and survival rates of patients undergoing dialysis. (A) Comparison of the causes of death for patients undergoing hemodialysis (HD) vs. peritoneal dialysis (PD) from 2001 to 2009. (B) Overall survival in registered patients undergoing dialysis since 2001 (male, 19,787; female, 14,688). (C) Survival of patients undergoing HD and PD since 2001 (HD, 27,579; PD, 6,896). (D) Overall survival of non-diabetes mellitus (DM) and patients with DM undergoing dialysis since 2001 (non DM, 17,932; DM, 16,543).

Figure 6

Kidney transplantation and dialysis costs. (A) Annual number of kidney transplantations (KTs) in Korea (including data from the Korean Network for Organ Sharing). ^aSurviving number of patients waiting for KTs at the end of each year. (B) Annual number of patients with chronic kidney disease (International disease code: N18) and medical costs. Data from the National Health Insurance Corporation.