Kidney replacement therapy for men and women according to the ERA Registry and the USRDS

Abstract

BACKGROUND: This paper compares the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates, and mortality on KRT between Europe and the United States (US), including sex comparisons. METHODS: Data were derived for 2022 from the population-based European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). RESULTS: In 2022, the KRT incidence in the US (388.7 per million population (pmp)) was 2.7-fold higher than in Europe (146.2 pmp), with a greater difference for women (3.2-fold) than for men (2.4-fold). The proportion of women initiating KRT was lower in Europe (35%) than in the US (41%). Between 2013 and 2022, the KRT incidence in Europe was stable in women (+0.1% annually), but increased in men (+1.1%). In the US, the KRT incidence increased similarly in women (+0.2%) and men (+0.3%). On 31 December 2022, the KRT prevalence was 2-fold (women: 2.2-fold, men: 1.9-fold) higher in the US (2444.2 pmp) than in Europe (1218.6 pmp). The proportion of women was lower in Europe (38%) than in the US (41%). The kidney transplantation rate was 1.7-fold higher in the US (79.1 pmp) than in Europe (45.4 pmp), 1.9-fold for women and 1.7-fold for men, with women accounting for 37% of the recipients versus 39% in the US. The KRT mortality rate was 1.5 times higher in the US (145.0 per 1000 patient years (/1000py)) compared to Europe (100.5/1000py): 1.6-fold for women and 1.4-fold for men. In Europe, mortality was lower for women receiving KRT (93.7/1000py) than for men (104.6/1000py), whereas in the US the reverse was (women: 148.9/1000py, men: 142.2/1000py). CONCLUSION: The US had a notably higher KRT incidence, prevalence, kidney transplantation rate and mortality compared to Europe. Differences between Europe and the US were larger for women than for men.