International

Worldwide increase in CKD patients

The prevalenceof end-stage renal disease (ESRD) is increasing worldwide¹. This is due to multiple factors including:

• improved testing and diagnosis of the disease²
• increases in predisposing comorbidities such as diabetes³
• improvement in survival rates in coronary heart disease (increasing the proportion of patients at risk of CKD)³
• demographic changes in the population, such as
  
  
  • increasing proportions of elderly patients³
  • increased ratio of men to women⁴
  • increasing incidence of diabetic nephropathy, hypertension and renal vascular disease³.

The most recent report of the United States Renal Data System (USRDS 2006*) has estimated that 472,099 patients were treated for ESRD in the US in the year 2004⁵. One estimate has forecasted that in the US, by 2010, the prevalence will rise by almost 40% and over 650,000 patients per year will require treatment for ESRD, including over 170,000 new cases presenting during that year^6,7. The increase in prevalence of chronic kidney disease (CKD) is exceeding the increase in the number of nephrologists and, therefore, the number of patients per physician is increasing⁷.

*The data reported here have been supplied by the United StatesRenal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S.government.

In light of the predicted increase in the number of patients with ESRD, changes should be established to simplify the way renal anaemia is managed. This could include:

• increasing the number of health care professionals; for example by giving nurses increased responsibility.
• improving dialysis technologies and other automated processes.
• investigating and developing new treatments that reduce the workload of the health care professionals.

Renal anaemia is treated with erythropoiesis-stimulating agents (ESAs), administered by subcutaneous or intravenous injection. Effective management is time consuming and labour-intensive because most CKD patients require injections up to 3 times a week to achieve target Hb levels⁸. Such frequent dosing is required because current ESAs are short-acting. This provides a significant workload for healthcare professionals requires additional administration costs and is associated with a higher risk of injection-related infections and needle break injuries compared with less frequent dosing. It is also inconvenient for the patient and can reduce treatment adherence⁹.

Next in this section (Importance of effective management)   

References:

1. Renal Association. UK Renal Registry. The Eighth Annual Report. December 2005.
2. Ruggenenti P, Remuzzi G. Kidney Failure Stabilizes after a Two-Decade Increase: Impact on Global (Renal and Cardiovascular) Health. Clin J Am Soc Nephrol 2007;2:146–50.
3. Schaubel DE, Morrison HI, Desmeules M, et al.End-stage renal disease in Canada: prevalence projections to 2005. CMAJ. 1999;160:1557–63.
4. Morduchowicz GA, Winkler J, Wittenberg C, et al.Renal replacement therapy in the ninth decade of life. Geriatr Nephrol Urol 1992;2:147-9.
5. US Renal Data System, USRDS 2006 Annual Data Report: atlas of end-stage renal disease in the United States, National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2006.
6. Xue JL, Ma JZ, Louis TA, Collins AJ.Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol. 2001;12:2753–8.
7. Osinski M, Wish J. Physician workforce: coming up short.Nephrol News Issues 2005;19:58–9,64,67.
8. National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for anaemia in chronic kidney disease. Am J Kid Dis 2006;47:S11–145.
9. Mahon A, Docherty B. Renal anaemia – the patient experience. EDTNA ERCA J 2004;30:34–7.