Worldwide disparity in the relation between CKD prevalence and kidney failure risk

Abstract Introduction The incidence of kidney replacement therapy (KRT) for kidney failure varies internationally much more than chronic kidney disease (CKD) prevalence. This ecologic study investigated the relation of CKD prevalence to KRT and mortality risks by world region. Methods We used data from Global Burden of Disease and KRT registries worldwide with linear models to estimate the percentages of variance in KRT incidence and all-cause mortality explained by age-adjusted prevalence of CKD stages 3-5, overall and by gender, in 61 countries classified in three regions: high-income (n=28), Eastern and Central Europe (n=15), and Other (n=18). Results The incidence of KRT ranged from 89 to 378 per million population in high-income regions, 32–222 in Central and Eastern Europe, and 22–493 in the Other region; age-adjusted CKD prevalence ranged respectively from 5.5 to 10.4%, 7.6–13.7%, and 7.4–13.1%. The relation between these indicators was positive in high-income countries, negative in Central and Eastern Europe, and null in the Other region. Age-adjusted CKD prevalence explained 40% of the variance in KRT incidence (P Conclusion This study raises awareness on the significant part of the gaps in KRT incidence across countries not explained by the number of individuals with CKD, even in high-income countries where access to KRT is not limited.