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

Abstract

BACKGROUND: This article compares the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates and mortality on KRT between Europe and the USA, 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 USA [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 USA (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 USA, 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 USA (2444.2 pmp) than in Europe (1218.6 pmp). The proportion of women was lower in Europe (38%) than in the USA (41%). The kidney transplantation rate was 1.7-fold higher in the USA (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 USA. The KRT mortality rate was 1.5 times higher in the USA [145.0 per 1000 patient-years (py)] compared with Europe (100.5 per 1000 py): 1.6-fold for women and 1.4-fold for men. In Europe, mortality was lower for women receiving KRT (93.7 per 1000 py) than for men (104.6 per 1000 py), whereas in the USA the reverse was true (women 148.9 per 1000 py, men 142.2 per 1000 py). CONCLUSION: The US had a notably higher KRT incidence, prevalence, kidney transplantation rate and mortality compared with Europe. Differences between Europe and the USA were larger for women than for men.