Global Dialysis Perspective: United States.

Abstract

Kidney failure, leading to ESKD, is invariably an irreversible condition that, for survival, typically requires RRT—either in the form of dialysis or a kidney transplant. ESKD is associated with high mortality and morbidity, lower quality of life, and high resource utilization and cost, thereby posing a substantial burden primarily on patients, but also on families and society at large. The focus of this mini-review is to summarize the state of dialysis management and changes in financing of dialysis in the United States over the last decade. In addition we briefly highlight the recently announced federal executive order, “Advancing American Kidney Health,” that promises to raise awareness and improve kidney disease management in the United States. Based on a survey of 79 countries (1), the United States has the second highest incidence of treated ESKD, which is attributed to age, race, genetic predisposition, and a high prevalence of risk factors such as obesity, diabetes, and hypertension (2). Primordial risk factors—such as inequities related to race, income, education, food security, recreational and routine physical activity, access to healthy food options, healthcare, and environmental factors—likely play a major role to in the predisposition to disease and its complications; kidney disease is no exception (3). There were 746,557 prevalent patients with ESKD in the United States at the end of 2017, 124,500 of which were new cases of ESKD, translating to a crude incidence rate of 370.2 per million per year (Figure 1). The adjusted ESKD incidence rate has stabilized, however, and has begun to decline slightly in recent years. About 30% of patients with prevalent ESKD and 3% of patients with incident ESKD had a functioning kidney transplant (4). For quite some time now, diabetes and hypertension have remained the leading assigned primary causes of ESKD in the United States (Table 1) (4 …