title: Worldwide access to treatment for end-stage kidney disease: a systematic review.
abstract: BACKGROUND
  End-stage kidney disease is a leading cause of morbidity and mortality worldwide. Prevalence of the disease and worldwide use of renal replacement therapy (RRT) are expected to rise sharply in the next decade. We aimed to quantify estimates of this burden.
  
  
  METHODS
  We systematically searched Medline for observational studies and renal registries, and contacted national experts to obtain RRT prevalence data. We used Poisson regression to estimate the prevalence of RRT for countries without reported data. We estimated the gap between needed and actual RRT, and projected needs to 2030.
  
  
  RESULTS
  In 2010, 2·618 million people received RRT worldwide. We estimated the number of patients needing RRT to be between 4·902 million (95% CI 4·438-5·431 million) in our conservative model and 9·701 million (8·544-11·021 million) in our high-estimate model, suggesting that at least 2·284 million people might have died prematurely because RRT could not be accessed. We noted the largest treatment gaps in low-income countries, particularly Asia (1·907 million people needing but not receiving RRT; conservative model) and Africa (432,000 people; conservative model). Worldwide use of RRT is projected to more than double to 5·439 million (3·899-7·640 million) people by 2030, with the most growth in Asia (0·968 million to a projected 2·162 million [1·571-3·014 million]).
  
  
  CONCLUSIONS
  The large number of people receiving RRT and the substantial number without access to it show the need to both develop low-cost treatments and implement effective population-based prevention strategies.
  
  
  BACKGROUND
  Australian National Health and Medical Research Council.
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Thaminda
authors.initials: T
authors.lastname: Liyanage
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: George Institute for Global Health, Splendor Forum, Jasola New Delhi, India; Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Vivekanand
authors.initials: V
authors.lastname: Jha
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.affiliation: Department of Clinical Sciences, Faculty of Medicine, University of Douala, Douala, Cameroon.
authors.forename: Halle Marie
authors.initials: HM
authors.lastname: Patrice
authors.affiliation: Division of Internal Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Ikechi
authors.initials: I
authors.lastname: Okpechi
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
authors.forename: Ming-hui
authors.initials: MH
authors.lastname: Zhao
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
authors.forename: Jicheng
authors.initials: J
authors.lastname: Lv
authors.affiliation: Department of Medicine, and Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Knight
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rodgers
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Gallagher
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Sradha
authors.initials: S
authors.lastname: Kotwal
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Menzies School of Health Research, Charles Darwin University, NT, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: vperkovic@georgeinstitute.org.au.
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D014943:Global Health; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D015995:Prevalence; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D055815:Young Adult