title: The gap between estimated incidence of end-stage renal disease and use of therapy.
abstract: BACKGROUND
  Relatively few data exist on the burden of end-stage renal disease (ESRD) and use of renal replacement therapy (RRT)-a life-saving therapy-in developing regions. No study has quantified the proportion of patients who develop ESRD but are unable to access RRT.
  
  
  METHODS
  We performed a comprehensive literature search to estimate use and annual initiation of RRT worldwide, and present these estimates according to World Bank regions. We also present estimates of survival and of etiology of diseases in patients undergoing RRT. Using data on prevalence of diabetes and hypertension, we modeled the incidence of ESRD related to these risk factors in order to quantify the gap between ESRD and use of RRT in developing regions.
  
  
  RESULTS
  We find that 1.9 million patients are undergoing RRT worldwide, with continued use and annual initiation at 316 and 73 per million population respectively. RRT use correlates directly (Pearson's r = 0.94) with regional income. Hemodialysis remains the dominant form of RRT but there is wide regional variation in its use. With the exception of the Latin American and Caribbean region, it appears that initiation of RRT in developing regions is restricted to fewer than a quarter of patients projected to develop ESRD. This results in at least 1.2 million premature deaths each year due to lack of access to RRT as a result of diabetes and elevated blood pressure and as many as 3.2 million premature deaths due to all causes of ESRD.
  
  
  CONCLUSIONS
  Thus, the majority of patients projected to reach ESRD due to diabetes or hypertension in developing regions are unable to access RRT; this gap will increase with rising prevalence of these risk factors worldwide.
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: Shuchi
authors.initials: S
authors.lastname: Anand
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaziano
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology; D005843:Geography; D005921:Glomerulonephritis / Q000150:complications / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D015994:Incidence; D007182:Income; D007676:Kidney Failure, Chronic / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000191:economics / Q000706:statistics & numerical data*; D016019:Survival Analysis; D014480:United Nations
references.citation: Artif Organs. 2002 Sep;26(9):737-46
references.pmid: 12197924
references.citation: Lancet. 2005 Jan 15-21;365(9455):217-23
references.pmid: 15652604
references.citation: N Engl J Med. 2006 Mar 9;354(10):997-9
references.pmid: 16525136
references.citation: Nephrol Dial Transplant. 2005 Dec;20(12):2587-93
references.pmid: 16204281
references.citation: J Am Soc Nephrol. 2002 May;13(5):1307-1320
references.pmid: 11961019
references.citation: Kidney Int. 2006 Sep;70(6):1107-14
references.pmid: 16883316
references.citation: JAMA. 2002 Oct 2;288(13):1589-93
references.pmid: 12350189
references.citation: Bull World Health Organ. 2008 Mar;86(3):229-37
references.pmid: 18368211
references.citation: Perit Dial Int. 2007 May-Jun;27(3):322-7
references.pmid: 17468485
references.citation: Perit Dial Int. 2009 Nov-Dec;29(6):618-22
references.pmid: 19910561
references.citation: Diabetes Care. 2004 May;27(5):1047-53
references.pmid: 15111519
references.citation: Lancet. 2011 Jul 2;378(9785):31-40
references.pmid: 21705069
references.citation: Int J Technol Assess Health Care. 2007 Winter;23(1):126-30
references.pmid: 17234026
references.citation: J Am Soc Nephrol. 2002 Jan;13 Suppl 1:S37-40
references.pmid: 11792760
references.citation: J Am Soc Nephrol. 2006 Aug;17(8):2275-84
references.pmid: 16790511
references.citation: Ren Fail. 2006;28(8):631-7
references.pmid: 17162420
references.citation: JAMA. 1997 Apr 23-30;277(16):1293-8
references.pmid: 9109467
references.citation: Perit Dial Int. 2010 Jan-Feb;30(1):23-8
references.pmid: 20056975
references.citation: Kidney Int. 2003 Jan;63(1):225-32
references.pmid: 12472787
references.citation: Lancet. 2011 Feb 12;377(9765):568-77
references.pmid: 21295844
references.citation: N Engl J Med. 1996 Jan 4;334(1):13-8
references.pmid: 7494564
references.citation: JAMA. 1997 Dec 17;278(23):2069-74
references.pmid: 9403420
references.citation: Ren Fail. 2004 May;26(3):201-8
references.pmid: 15354966
references.citation: Perit Dial Int. 2009 Feb;29 Suppl 2:S217-21
references.pmid: 19270222
references.citation: Kidney Int Suppl. 2003 Feb;(83):S128-30
references.pmid: 12864891
references.citation: Perit Dial Int. 2010 May-Jun;30(3):269-73
references.pmid: 20424195