Renal replacement therapy in Korea, 2012

Abstract

The Korean Society of Nephrology (KSN) launched the official end-stage renal disease (ESRD) patient registry in 1985, and an Internet online registry program was opened in 2001 and revised in 2013. The ESRD Registry Committee of KSN has collected data on dialysis therapy in Korea through the online registry program in the KSN Internet website. The status of renal replacement therapy in Korea at the end of 2012 is described in the following. The total number of ESRD patients was 70,211 at the end of 2012, which included 48,531 hemodialysis (HD) patients, 7,552 peritoneal dialysis (PD) patients, and 14,128 functioning kidney transplant (KT) patients. The prevalence of ESRD was 1,353.3 patients per million population (PMP), and the distribution of renal replacement therapy among ESRD patients was as follows: HD, 69.1%; PD, 10.8%; and KT, 20.2%. The number of new ESRD patients in 2012 was 11,742 (HD, 8,811; PD, 923; and KT, 1,738; the incidence rate was 221.1 PMP). The primary causes of ESRD were diabetic nephropathy (50.6%), hypertensive nephrosclerosis (18.5%), and chronic glomerulonephritis (18.1%). The mean urea reduction ratio was 67.9% in male and 74.1% in female HD patients. The mean Kt/V was 1.382 in male and 1.652 in female HD patients. The 5-year survival rates of male and female dialysis patients were 70.6% and 73.5%, respectively.

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

Figure 1

Prevalence and incidence of end-stage renal replacement therapy in Korea. The number of patients with renal replacement therapy at the end of each year (A); point prevalence of renal replacement therapy (B); patients starting renal replacement therapy each year (C); and three major causes of end-stage renal disease (D). CGN, chronic glomerulonephritis; DM, diabetic nephropathy; HD, hemodialysis; HTN, hypertensive nephrosclerosis; KT, kidney transplantation; PD, peritoneal dialysis; PMP, patient numbers per million population; RRT, renal replacement therapy.

Figure 2

Renal replacement therapy modalities. Proportion of renal replacement modalities (annual prevalence and incidence in 2012) (A); the numbers of hemodialysis centers and hemodialysis machines (B), and hemodialysis patients and hemodialysis patients per hemodialysis machine (C); percent distribution of hemodialysis patients according to dialysis center classification (D); and regional distribution of dialysis patients in Korea (E). HD, hemodialysis; KT, kidney transplantation; PD, peritoneal dialysis.

Figure 3

Dialysis patient demographics. Gender ratio of HD and PD patients according to year (A); ABO blood type and hepatitis virus of HD and PD patients (B); age distribution of dialysis patients according to dialysis modalities (C), years (D), and underlying diseases (E); duration of maintenance HD and PD versus percent of estimated patient number according to year (F); duration of dialysis maintenance in diabetic and nondiabetic patients (G); distribution of BMI (H) and mean blood pressure (I) in HD and PD patients (blood pressure is higher in HD patients than in PD patients); and systolic and diastolic blood pressures with pulse pressure in HD and PD patients (J). BMI, body mass index; BP, blood pressure; DM, diabetic patients; HD, hemodialysis; HTN, hypertensive nephrosclerosis; GN, glomerulonephritis; MBP, mean blood pressure; PD, peritoneal dialysis.

Figure 4

Characteristics of HD, PD, and erythropoietin therapy. Frequency of hemodialysis per week (A); percent of HDF-applied patients and dialyzer membrane surface area (B); hemodialysis dialysate (C); vascular access for HD (D); PD catheter type and PD catheter insertion methods (E); Distribution of peritoneal dialysis types and doses (percentage) (F); changes in hemoglobin level in dialysis patients, HD versus PD (note the increase of hemoglobin in HD patients) (G); percent distribution of erythropoietin doses prescribed for HD and PD patients (H); distribution of patients numbers according to calcium and phosphorous levels (I); PTH levels of HD and PD patients (x-axis is on nature logarithmic scale) (J); phosphate binders and PTH control medications (K); distribution of URR in hemodialysis patients (L); dialysis adequacy parameters (nPCR and spKT/V) in HD patients (M); dialysis adequacy parameters (spKt/V) in diabetic and nondiabetic HD patients (N); and distribution of patient numbers according to nPCR and spKt/V in HD patients (O) and according to nPNA and Kt/V in PD patients (P). APD, automated peritoneal dialysis; AVF, arteriovenous fistula; CAPD, continuous ambulatory peritoneal dialysis; EPO, erythropoietin; Hct, hematocrit; HD, hemodialysis; HDF, hemodiafiltration; nPCR, normalized protein catabolic rate; nPNA, normalized protein nitrogen appearance; PD, peritoneal dialysis; PTH, parathyroid hormone; spKt, single-pool Kt/V; URR, urea reduction ratio.

Figure 4

Characteristics of HD, PD, and erythropoietin therapy. Frequency of hemodialysis per week (A); percent of HDF-applied patients and dialyzer membrane surface area (B); hemodialysis dialysate (C); vascular access for HD (D); PD catheter type and PD catheter insertion methods (E); Distribution of peritoneal dialysis types and doses (percentage) (F); changes in hemoglobin level in dialysis patients, HD versus PD (note the increase of hemoglobin in HD patients) (G); percent distribution of erythropoietin doses prescribed for HD and PD patients (H); distribution of patients numbers according to calcium and phosphorous levels (I); PTH levels of HD and PD patients (x-axis is on nature logarithmic scale) (J); phosphate binders and PTH control medications (K); distribution of URR in hemodialysis patients (L); dialysis adequacy parameters (nPCR and spKT/V) in HD patients (M); dialysis adequacy parameters (spKt/V) in diabetic and nondiabetic HD patients (N); and distribution of patient numbers according to nPCR and spKt/V in HD patients (O) and according to nPNA and Kt/V in PD patients (P). APD, automated peritoneal dialysis; AVF, arteriovenous fistula; CAPD, continuous ambulatory peritoneal dialysis; EPO, erythropoietin; Hct, hematocrit; HD, hemodialysis; HDF, hemodiafiltration; nPCR, normalized protein catabolic rate; nPNA, normalized protein nitrogen appearance; PD, peritoneal dialysis; PTH, parathyroid hormone; spKt, single-pool Kt/V; URR, urea reduction ratio.

Figure 5

Rehabilitation, morbidities, causes of death, and survival rates of dialysis patients. Rehabilitation status of HD and PD patients in 2012 (A); comparison of causes of death in HD versus PD patients in 2001–2012 (B); overall survival of dialysis patients registered since 2001 (C); survival of HD and PD patients since 2001 (D); and patient survival according to underlying diseases since 2001 (E). DM, diabetic nephropathy; GN, glomerulonephritis; HD, hemodialysis; HTN, hypertensive nephrosclerosis; Misc, miscellaneous; PD, peritoneal dialysis.

Figure 6

Annual number of KTs in Korea (including data from the KONOS). Surviving KT waiting patient number at the end of each year. KONOS, Korean Network for Organ Sharing; KT, kidney transplantation.