Lessons from 30 years' data of Korean end-stage renal disease registry, 1985-2015

Abstract

The Korean Society of Nephrology (KSN) launched a nationwide official survey program about dialysis therapy in 1985. Nowadays, the accumulated data for 30 years by this "Insan Prof. Min Memorial end-stage renal disease (ESRD) Registry" program have been providing the essential information for dialysis clinical practice, academic nephrology research, and health management policy. We reviewed 30 years of data to identify important changes and implications for the future improvement of dialysis therapy in Korea. Hemodialysis patients, especially diabetics and elderly patients have increased in number very rapidly during recent years in Korea. The Korean prevalence rate of ESRD patients was about 70% of the United States and about 50% of Japan according to the international comparisons in the annual data report of United States Renal Data System. The blood pressure control, anemia control, and dialysis adequacy have continuously improved year by year. The importance of calcium and phosphorus control has also been increasing because of the increase in long-term dialysis patients. In addition, chronic dialysis complications should be closely monitored and dialysis modifications, such as hemodiafiltration therapy, might be considered. Because of the increase of private clinics and nursing hospitals in dialysis practice, the role of dialysis specialists and continuing education are thought to be essential. For strict cost-effective dialysis control of increasing elderly, diabetic, and long-term dialysis patients, the KSN ESRD patient registration should be run by the KSN and health ministry in cooperation, in which the dialysis fee reimbursement should be accompanied.

Keywords: End-stage renal disease; Hemodialysis; Peritoneal dialysis; Registry.

Figure 1

Dialysis prevalence. (A) The number of patients with renal replacement therapy at the end of each year. (B) Changes in the proportion of three major causes of end-stage renal disease. (C) Age distribution of dialysis patients according to underlying diseases. (D) Duration of maintenance HD and PD. Percent of estimated patient number according to year. (E) Distribution of mean arterial pressure in HD and PD patients. Blood pressure was higher in HD patients than in PD patients. (F) Systolic and diastolic blood pressure with pulse pressure in HD and PD patients. BP, blood pressure; CGN, chronic glomerulonephritis; DM, diabetic nephropathy; HD, hemodialysis; HTN, hypertensive nephrosclerosis; KT, kidney transplantation; MAP, mean arterial pressure; PD, peritoneal dialysis.

Figure 2

Dialysis characteristics. (A) Vascular access for HD. (B) PD catheter type and PD catheter insertion methods. (C) Changes of Hb in dialysis patients, HD versus PD. (D) Percent distribution of EPO doses prescribed for HD and PD patients. (E) Distribution of patient numbers according to the calcium and phosphorus levels. (F) Phosphate binders and parathyroid control medications. AVF, arteriovenous fistula; EPO, erythropoietin; Hb, hemoglobin; HD, hemodialysis; PD, peritoneal dialysis; PTH, parathyroid hormone.

Figure 3

Dialysis adequacy, rehabilitation, and survival. (A) Distribution of URR in HD patients. (B) Distribution of patient numbers according to nPCR and single-pool Kt/V in HD patients. (C) Rehabilitation status of HD and PD patients. (D) Patient survival according to underlying diseases since 2001. DM, diabetic nephropathy; GN, glomerulonephritis; HD, hemodialysis; HTN, hypertensive nephrosclerosis; Misc, miscellaneous; nPCR, normalized protein catabolic rate; PD, peritoneal dialysis; URR, urea reduction ratio.