Supplementary Material for: Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy

<b><i>Background:</i></b> The global epidemiology of end-stage kidney disease (ESKD) reflects each nation’s unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESKD, particularly regarding kidney replacement therapy (KRT), depends on local disease burden, culture, and socioeconomics. Here, we explore geographic variation and global trends in ESKD incidence and prevalence and examine variations in KRT modality, practice patterns, and mortality. We conclude with a discussion on disparities in access to KRT and strategies to reduce ESKD global burden and to improve access to treatment in low- and middle-income countries (LMICs). <b><i>Summary:</i></b> From 2003 to 2016, incidence rates of treated ESKD were relatively stable in many higher income countries but rose substantially predominantly in East and Southeast Asia. The prevalence of treated ESKD has increased worldwide, likely due to improving ESKD survival, population demographic shifts, higher prevalence of ESKD risk factors, and increasing KRT access in countries with growing economies. Unadjusted 5-year survival of ESKD patients on KRT was 41% in the USA, 48% in Europe, and 60% in Japan. Dialysis is the predominant KRT in most countries, with hemodialysis being the most common modality. Variations in dialysis practice patterns account for some of the differences in survival outcomes globally. Worldwide, there is a greater prevalence of KRT at higher income levels, and the number of people who die prematurely because of lack of KRT access is estimated at up to 3 times higher than the number who receive treatment. <b><i>Key Messages:</i></b> Many people worldwide in need of KRT as a life-sustaining treatment do not receive it, mostly in LMICs where health care resources are severely limited. This large treatment gap demands a focus on population-based prevention strategies and development of affordable and cost-effective KRT. Achieving global equity in KRT access will require concerted efforts in advocating effective public policy, health care delivery, workforce capacity, education, research, and support from the government, private sector, nongovernmental, and professional organizations.

<b><i>研究背景：</i></b> 终末期肾病（end-stage kidney disease, ESKD）的全球流行病学特征，反映了各国独特的遗传、环境、生活方式以及社会人口学特征。针对终末期肾病的应对策略，尤其是肾脏替代治疗（kidney replacement therapy, KRT）的实施方案，取决于当地的疾病负担、文化背景与社会经济状况。本研究旨在探讨终末期肾病发病率与患病率的地域差异及全球趋势，并分析肾脏替代治疗的方式、诊疗模式与死亡率差异。最后，我们将讨论肾脏替代治疗可及性方面的不平等现象，以及减轻全球终末期肾病负担、改善中低收入国家（low- and middle-income countries, LMICs）患者治疗可及性的策略。<b><i>研究概要：</i></b> 2003年至2016年间，许多高收入国家的接受治疗的终末期肾病发病率相对平稳，但在东亚与东南亚地区，该发病率出现了显著攀升。全球范围内接受治疗的终末期肾病患病率均有所上升，这可能归因于终末期肾病患者生存率的提升、人口结构变迁、终末期肾病危险因素患病率升高，以及经济增长国家肾脏替代治疗可及性的改善。接受肾脏替代治疗的终末期肾病患者未经校正的5年生存率，在美国为41%，欧洲为48%，日本为60%。在大多数国家，透析是主要的肾脏替代治疗方式，其中血液透析最为普遍。透析诊疗模式的差异是导致全球范围内患者生存结局存在差异的部分原因。全球范围内，高收入经济体的肾脏替代治疗患病率更高；因无法获得肾脏替代治疗而过早死亡的人数，据估算可达接受治疗人数的3倍之多。<b><i>核心要点：</i></b> 全球范围内，众多需要肾脏替代治疗以维持生命的患者无法获得该治疗，这一情况在医疗资源严重匮乏的中低收入国家尤为突出。如此巨大的治疗缺口，亟需我们聚焦于基于人群的预防策略，并研发可负担且具有成本效益的肾脏替代治疗方案。要实现肾脏替代治疗可及性的全球公平，需要各方协同努力：倡导有效的公共政策、优化医疗服务供给、提升医护人员能力、加强教育与研究，并获得政府、私营部门、非政府组织以及专业机构的支持。