Epidemiology of haemodialysis outcomes

Abstract

Haemodialysis (HD) is the commonest form of kidney replacement therapy in the world, accounting for approximately 69% of all kidney replacement therapy and 89% of all dialysis. Over the last six decades since the inception of HD, dialysis technology and patient access to the therapy have advanced considerably, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes vary widely across the world and, overall, the rates of impaired quality of life, morbidity and mortality are high. Cardiovascular disease affects more than two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality. In addition, patients on HD have high symptom loads and are often under considerable financial strain. Despite the many advances in HD technology and delivery systems that have been achieved since the treatment was first developed, poor outcomes among patients receiving HD remain a major public health concern. Understanding the epidemiology of HD outcomes, why they might vary across different populations and how they might be improved is therefore crucial, although this goal is hampered by the considerable heterogeneity in the monitoring and reporting of these outcomes across settings.

Conflict of interest statement

V.J. has received fees from AstraZeneca, NephroPlus and Zydus Cadilla, and grants from Baxter Healthcare, Biocon and GlaxoSmithKline; all funds are paid to his organization. D.W.J. has received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from Astra Zeneca, Bayer and AWAK, speaker’s honoraria from ONO and BI & Lilly, and travel sponsorships from Ono and Amgen. The other authors declare no competing interests.

© 2022. Springer Nature Limited.

Figures

Fig. 1. Hierarchy of importance of haemodialysis outcomes to patients, caregivers and clinicians.

The Standardized Outcomes in Nephrology in Haemodialysis initiative has identified a hierarchy of HD outcomes according to their level of importance to stakeholder groups,–. The outcomes in the top tier are critically important to all stakeholder groups, those in the middle tier are critically important to some stakeholder groups and those in the bottom tier are important to some or all stakeholder groups. Adapted with permission from Tong et al., Elsevier.

Fig. 2. Expected remaining years of life in prevalent patients on dialysis.

Expected remaining lifetime, in years, for the 2018 prevalent kidney failure population and the 2017 general population in the USA. The graph illustrates the markedly shortened projected lifespan for patients with kidney failure compared with that of individuals without kidney failure. In individuals aged 40–44 years, for example, the projected lifespan difference between men receiving dialysis (expectancy 10.9 years) and men in the general population (expectancy 36.5 years) is >25 years (>30 years for women). Unsurprisingly, the difference in expected remaining years of life decreases with increasing age. However, even men and women aged 80–84 years on dialysis have life expectancies that are 4.3 and 5.3 years shorter, respectively, than their counterparts who are not receiving dialysis. Graph is reprinted from United States Renal Data System, CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/).

Fig. 3. Incidence of treated kidney failure by sex in different countries or regions (2018).

The figure depicts an international comparison of the incidence of treated kidney failure by country or region displaying information among countries and regions that supplied data to the US Renal Data System for the year 2018. The highest incidences (≥400 persons with treated kidney failure per million population) were observed in the Mexican state of Jalisco, Taiwan and Hungary, whereas the lowest incidences (https://creativecommons.org/licenses/by/4.0/).

Fig. 4. Haemodialysis quality indicators monitored and reported in 144 countries.

The figure depicts data from the Global Kidney Health Atlas with 144 countries contributing data on reporting HD quality-of-care metrics. This reporting was assessed by examining the percentage proportion of centres (in each participating country) that routinely monitored and reported the outcomes or parameters (patient-reported outcome measures, blood pressure, small solute clearance, haemoglobin or haematocrit, and technique and patient survival) in a country. Adapted with permission from Htay et al., Elsevier.