Worldwide access to treatment for end-stage kidney disease: A systematic review

Thaminda Liyanage, Toshiharu Ninomiya, Vivekanand Jha, Bruce Neal, Halle Marie Patrice, Ikechi Okpechi, Ming Hui Zhao, Jicheng Lv, Amit X. Garg, John Knight, Anthony Rodgers, Martin Gallagher, Sradha Kotwal, Alan Cass, Vlado Perkovic

Research output: Contribution to journalArticlepeer-review

1315 Citations (Scopus)


Background End-stage kidney disease is a leading cause of morbidity and mortality worldwide. Prevalence of the disease and worldwide use of renal replacement therapy (RRT) are expected to rise sharply in the next decade. We aimed to quantify estimates of this burden. Methods We systematically searched Medline for observational studies and renal registries, and contacted national experts to obtain RRT prevalence data. We used Poisson regression to estimate the prevalence of RRT for countries without reported data. We estimated the gap between needed and actual RRT, and projected needs to 2030. Findings In 2010, 2·618 million people received RRT worldwide. We estimated the number of patients needing RRT to be between 4·902 million (95% CI 4·438-5·431 million) in our conservative model and 9·701 million (8·544-11·021 million) in our high-estimate model, suggesting that at least 2·284 million people might have died prematurely because RRT could not be accessed. We noted the largest treatment gaps in low-income countries, particularly Asia (1·907 million people needing but not receiving RRT; conservative model) and Africa (432 000 people; conservative model). Worldwide use of RRT is projected to more than double to 5·439 million (3·899-7·640 million) people by 2030, with the most growth in Asia (0·968 million to a projected 2·162 million [1·571-3·014 million]). Interpretation The large number of people receiving RRT and the substantial number without access to it show the need to both develop low-cost treatments and implement effective population-based prevention strategies. Funding Australian National Health and Medical Research Council.

Original languageEnglish
Pages (from-to)1975-1982
Number of pages8
JournalThe Lancet
Issue number9981
Publication statusPublished - May 16 2015
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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