Epidemiology and Outcomes of Renal Replacement Therapy
Summary
Renal replacement therapy (RRT) encompasses haemodialysis, peritoneal dialysis and kidney transplantation as life-sustaining treatments for people with end-stage renal disease (ESRD). Globally, RRT incidence and prevalence have risen steadily over recent decades, driven principally by population ageing, increasing rates of diabetes and hypertension, and expanding access to care in middle-income regions. Incidence rates vary widely, from fewer than 100 per million population (pmp) in some countries to over 350 pmp in others, reflecting differences in health-care infrastructure, referral patterns and clinical practice. Survival on RRT has improved modestly, with five-year adjusted survival hovering around 60 percent for dialysis cohorts and exceeding 85 percent following living-donor transplantation. Early mortality remains high, particularly within the first year of dialysis initiation, and is influenced by advanced age, cardiovascular disease, malnutrition and suboptimal vascular access. Peritoneal dialysis offers comparable survival in selected populations and greater autonomy, whereas transplantation confers the best long-term outcomes but remains limited by organ shortage. Population-based registries and large cohort studies have been instrumental in elucidating demographic trends, regional disparities and the impact of comorbidities on outcomes. Ongoing efforts centre on optimising timing of dialysis initiation, enhancing pre-dialysis care, improving access to home therapies and expanding transplant programmes to reduce the global burden of ESRD.
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Epidemiology and Outcomes of Renal Replacement Therapy publication trend
The graph below shows the total number of articles in epidemiology and outcomes of renal replacement therapy across all publications each year (not limited to Nature Index journals).
Technical terms
End-stage renal disease (ESRD): The final, irreversible stage of chronic kidney disease requiring RRT.
Renal replacement therapy (RRT): Medical treatments that replace non-endocrine kidney functions, including dialysis and transplantation.
Haemodialysis: A dialysis modality that removes waste and excess fluid by circulating blood through an external filter.
Peritoneal dialysis: A modality that uses the peritoneal membrane as a natural filter, with dialysate instilled into the abdominal cavity.
Kaplan–Meier analysis: A statistical method to estimate survival probabilities over time in cohort studies.
Hazard ratio (HR): A measure of the relative risk of an event (e.g., death) occurring in one group compared with another over time.
References
- Variability in the incidence of renal replacement therapy over time in Western industrialized countries: A retrospective registry analysis. PLOS ONE (2020).
- Trend and determinants of mortality in incident hemodialysis patients of the Lazio region. BMC Nephrology (2023).
- Mortality risk in patients with autosomal dominant polycystic kidney disease. BMC Nephrology (2024).
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