Trends in epidemiologic characteristics of end-stage renal disease from 2019 Korean Renal Data System (KORDS)

Abstract

Background: The Korean Society of Nephrology (KSN) has maintained a nationwide end-stage renal disease (ESRD) registry data from Korean Renal Data System (KORDS) since 1985, as the representative registry of ESRD patients in Korea. This review is aimed to update the status of domestic ESRD and to provide evidence on the direction of dialysis therapy.

Methods: The KORDS Committee of KSN has collected data on dialysis centers and patients through an online registry program, and the data from 1986 to 2019 were analyzed.

Results: The incidence and prevalence of ESRD patients in Korea are increasing. The ESRD population numbered more than 100,000 in 2019, doubling during the 10 years since 2010. The proportion of diabetes mellitus as a major cause of ESRD seems to have reached a plateau. The increasing number of elderly dialysis patients is a constant trend, with more than half for the proportion of patients older than 65 years old in 2019. All-cause mortality decreased for the last approximately 20 years, regardless of sex, age, and cause of ESRD. The 5-year patient survival rate in both hemodialysis and peritoneal dialysis increased from 2001 to 2013. Since 2013, the patient survival rates in peritoneal dialysis were similar to those in hemodialysis. Cardiovascular complications were the leading cause of death in ESRD patients.

Conclusions: The incidence and prevalence of Korean ESRD patients have increased over time, although patient survival has also steadily increased. The establishment of a surveillance method to address the major cause of mortality in ESRD patients will help improve outcomes.

Keywords: End-stage renal disease; Incidence; Mortality; Prevalence.

Figure 1.. Incidence and prevalence of renal replacement therapy in Korea.

(A) Annual incidence of RRT in Korea. (B) Proportion of renal replacement modalities (annual incidence from 1986 to 2019). (C) Annual prevalence of RRT in Korea. (D) The current status of RRT (per million population) in Korea through internal comparisons. HD, hemodialysis; KT, kidney transplantation; PD, peritoneal dialysis; RRT, renal replacement therapy.

Figure 2.. Prevalent percentages based on underlying cause of end-stage renal disease and age distribution in Korea.

(A) Underlying causes of ESRD. (B) Mean ages of dialysis patients according to primary renal disease. (C) The proportion of dialysis patients over 65 years old. DM, diabetes mellitus; ESRD, end-stage renal disease; GN, glomerulonephritis; HTN, hypertension.

Figure 3.

Numbers of hemodialysis (HD) centers and HD machines in Korea.

Figure 4.. Unadjusted all-cause mortality for all-dialysis patients, 2001 to 2018.

(A) Treatment modality, (B) sex, (C) age, and (D) primary renal diseases. DM, diabetes mellitus; GN, glomerulonephritis; HD, hemodialysis; HTN, hypertension; PD, peritoneal dialysis.

Figure 5.. Unadjusted relative percentages for cause of death of dialysis patients in 2019.

(A) Major causes of death and (B) detailed cause-specific death.

Figure 6.. Trends for proportions of causes of death during the incident year, 2001 to 2019.