Epidemiology of end-stage kidney disease

Abstract

End-stage kidney disease (ESKD) is a common and morbid disease that affects patients' quality and length of life, representing a large portion of health care expenditure in the United States. These patients commonly have associated diabetes and cardiovascular disease, with high rates of cardiovascular-related death. Management of ESKD requires renal replacement therapy via dialysis or transplantation. While transplantation provides the greatest improvement in survival and quality of life, the vast majority of patients are treated initially with hemodialysis. However, outcomes differ significantly among patient populations. Barriers in access to care have particularly affected at-risk populations, such as Black and Hispanic patients. These patients receive less pre-ESKD nephrology care, are less likely to initiate dialysis with a fistula, and wait longer for transplants-even in pediatric populations. Priorities for ESKD care moving into the future include increasing access to nephrology care in underprivileged populations, providing patient-centered care based on each patient's "life plan," and focusing on team-based approaches to ESKD care. This review explores ESKD from the perspective of epidemiology, costs, vascular access, patient-reported outcomes, racial disparities, and the impact of the COVID-19 crisis.

Fig. 1 –

Adjusted end-stage renal disease (ESRD) incidence 1990 to 2018. Data from US Renal Data Service 2020 Annual Report on Chronic Kidney Disease and End Stage Renal Disease [5].

Fig. 2 –

End-stage renal disease (ESRD) treatment by modality in 2018. Data from US Renal Data Service 2020 Annual Report on Chronic Kidney Disease and End Stage Renal Disease [5].

Fig. 3 –

Expected life span in male patients (A) and female patients (B) with end-stage kidney disease (ESKD) by treatment modality compared with non-ESKD patients. Data from US Renal Data Service 2020 Annual Report on Chronic Kidney Disease and End Stage Renal Disease.