Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, ESRD Registry Committee, Korean Society of Nephrology*
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1 Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, ESRD Registry Committee, Korean Society of Nephrology* =Abstracts= Registry committee of Korean Society of Nephrology has collected data about dialysis in Korea through on-line registry program in KSN internet web site. The status of renal replacement therapy in Korea at the end of 2011 was as follows: 1) The total number of patients with renal replacement therapy (RRT) was 63,341 (hemodialysis : HD 42,596, peritoneal dialysis : PD 7,694, functioning kidney transplant :KT 13,051). Prevalence of RRT was 1,224.8 patients per million population (pmp). The proportion of RRT was HD 67.2%, PD 12.1%, and renal transplant 20.6%. 2) New RRT patients in 2011 were 10,616 (HD 8,057, PD 920, KT 1,639). Incidence rate was pmp in ) The most common primary cause of end stage renal diseases was diabetic nephropathy (47.1%), hypertensive nephrosclerosis (19.6%) and chronic glomerulonephritis (10.4%), in order. 4) The number of RRT centers was 656 and total number of HD machines was 16,561. Dialysis patients' individual data were collected from 71.5% of overall RRT centers. 5) Mean age of HD patient was 59.1 years old, of PD was 54.7 years old. Proportion of patients on HD more than 5 years' maintenance was 44%. 6) Mean BMI (body mass index; Kg/m 2 ) of HD patients was 21.96Kg/m 2 and BMI of PD patients was 23.69Kg/m 2. Mean blood pressure was 100.7mmHg in HD and 99.0mmHg in PD patients. Pulse pressure was 64.1mmHg in HD and 52.9mmHg in PD patients. 7) Mean hemoglobin of HD patient was 10.4g/dL (hematocrit 31.5%), PD was 10.2g/dL (Hct: 30.1%). 8) Mean urea reduction ratio was 68.1% in male HD patients and 74.1% in female HD patients. Mean Kt/V was in male patient, in female patients. 9) The common co-morbid diseases of HD patients were hypertension (43.0%), coronary artery disease (6.7%), hepatitis B (4.8%), and those of PD patients were also hypertension (51.2%), congestive heart failure (7.0%), coronary artery disease (7.0%). 10) Overall patient survival of male dialysis patient in 5 years was 65.3%, female patients was 68.0%. HD patient's 5 year survival was 67.8% and PD was 59.1%. Five year survival of diabetic dialysis patients was 56.9%, chronic glomerulonephritis patients 83.1%, hypertensive nephrosclerosis patients 75.7%, respectively. 11) Common causes of death were unknown cause or not uremia associated cardiac arrest (15.0%), uremia associated cardiac arrest (11.0%), sepsis (10.4%), cerebro-vascular accident (8.7%) and myocardial infarction (6.6%) in ) The number of kidney transplantation was 1,639 (deceased donor 680) in Key words: renal replacement therapy, hemodialysis, peritoneal dialysis, kidney transplantation, prevalence, incidence, survival, dialysis adequacy * ESRD registry committee, Korean Society of Nephrology : - Director : Dong Chan Jin (Catholic Univ. of Korea, jindongc@catholic.ac.kr) - Members : Nam Ho Kim (Chonnam National Univ.), Seoung Woo Lee (Inha Univ.), Jong Soo Lee (Ulsan Univ.), Sung Ro Yoon (Kyunyang Univ.), Byung Su Kim (Catholic Univ.)
2 Part 1. Prevalence & Incidence of ESRD (1) Table 1-1. Prevalence of renal replacement therapy. Fig Patient numbers of renal replacement therapy at the end of each year. Fig Point prevalence of renal replacement therapy (Patients numbers per million population, HD: hemodialysis, PD: peritoneal dialysis, KT: kidney transplantation).
3 Part 1. Prevalence & Incidence of ESRD (2) Table 1-2. Number of new renal replacement therapy patients. Fig.1-3. New renal replacement therapy patients number in each year. Table 1-3. Causes of end stage renal disease in new patients. Fig.1-4. Three major causes of end stage renal disease patients who were initiated renal replacement therapy in each year. (DM: diabetic nephropathy, CGN: chronic glomerulonephritis, HTN: hypertensive nephrosclerosis). Note increase of DM and decrease of CGN.
4 Part 2. Renal Replacement Therapy Modalities Fig Proportion of renal replacement modalities, annual prevalence and incidence. HD: hemodialysis, PD: peritoneal dialysis, KT: kidney transplantation. Fig Numbers of dialysis centers, hemodialysis machines and machine per each dialysis center in Korea. Fig Number of hemodialysis patients and hemodialysis patients per hemodialysis machine. Fig.2-4. Percentage of hemodialysis patients number according to dialysis center.
5 Part 3. Regional Distribution of Patients & Facilities Table 3-1. Administrative regional distribution of dialysis patients & hemodialysis machines. Table 3-2. Distribution of dialysis patients and machines according to life zone*. Fig Distribution of dialysis patients and machines according to life zone. Fig Regional proportion of dialysis patient number in each year.
6 Part 4. Dialysis Patients Demographics (1) Table 4-1. Percent of dialysis centers contributing individual patient data. Fig Individual patients data contributing rate of dialysis centers according to hospital classification. Fig.4-2. Gender ratio of HD & PD patients according to years.
7 Part 4. Dialysis Patients Demographics (2) - Age Fig Age distribution of dialysis patients according to dialysis modalities. Fig.4-4. Age distribution of dialysis patients according to years. Note the peak age was shift to old age. Fig.4-5. Elderly dialysis patient (over 65 year-old) proportion according to year. Fig Age distribution of dialysis patients according to underlying diseases, diabetic patients (DM), hypertensive nephrosclerosis (HTN) and glomerulonephritis (GN). Note difference of peak age between GN and DM.
8 Part 4. Dialysis Patients Demographics (3) - Dialysis Duration Fig Duration of maintenance hemodialysis and peritoneal dialysis. Percent of estimated patient number according to year. Fig 4-8. Diabetic and non-diabetic patient's duration of dialysis maintenance.
9 Part 4. Dialysis Patients Demographics (4) - BMI & BP Fig Distribution of body mass index (BMI) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Fig Distribution of mean blood pressure (MBP) in hemodialysis and peritoneal dialysis patients. Blood pressure of HD patients was higher than PD patients BP. Fig Systolic and diastolic blood pressure with pulse pressure in hemodialysis and peritoneal dialysis patients. Note difference of pulse pressure between HD and PD patients.
10 Part 5. Dialysis Therapy (1) - Anemia & Erythropoietin Fig.5-1. Distribution of hematocrit levels in hemodialysis and peritoneal dialysis patients. Also mean of hemoglobin level of HD and PD patients were shown. Fig.5-2. Percent distribution of prescribed erythropoietin doses for hemodialysis and peritoneal dialysis patients.
11 Part 5. Dialysis Therapy (2) - HD frequency & Dialyzer Fig.5-3. Frequency of hemodialysis per week. Fig.5-4. Currently using hemodialysis membranes, reuse of dialysis membrane and hemodiafiltration performing center percent.
12 Part 5. Dialysis Therapy (3) - HD Adequacy Fig.5-5. Distribution of urea reduction ratio (URR) of hemodialysis patients. Note the difference between male and female. Fig.5-6. Dialysis adequacy parameters (npcr & KT/V) of hemodialysis patients. Fig.5-7. Dialysis adequacy parameters (Kt/V) of diabetic and non-diabetic hemodialysis patients.
13 Part 5. Dialysis Therapy (4) - Peritoneal Dialysis Fig Percent distribution of peritoneal dialysis type and doses per day. Part 6. Co-morbidity of Dialysis Patients Table 6-1. Co-morbidity of dialysis patients in 2011*.
14 Part 7. Causes of Death in Dialysis Patients Table 7-1. Causes of death (%) in dialysis patients, Fig.7-1. Comparison of death causes, hemodialysis versus peritoneal dialysis patients in
15 Part 8. Survival of Dialysis Patients (1) - Overall Fig.8-1. Overall registered dialysis patient survival since (male : n=24,680, female : n=18,257). Fig.8-2. HD & PD dialysis patient survival since 2001 (HD : n=35,055, PD : n=7,882).
16 Part 8. Survival of Dialysis Patients (2) - according to diseases & modalities Fig Patient survival according to underlying diseases since 2001 (DM : n=20,916, glomerulonephritis (GN): n= 4,172 hypertension (HTN):n= 8,142, miscellaneous (Misc): n= 9,708). Fig Patient survival according to underlying diseases in hemodialysis patients since 2001 (DM : n=17,431, Glomerulonephritis (GN): n= 3,295 hypertension(htn):n= 6,438, miscellaneous (Misc): n= 7,891). Fig Patient survival according to underlying diseases in peritoneal dialysis patients since 2001 (DM : n=3,485, Glomerulonephritis (GN): n= 877 hypertension(htn):n= 1,703, miscellaneous (Misc): n= 1,817).
17 Fig Survival of diabetic dialysis patient according to dialysis modalities since 2001 (HD : n=17,431 PD : n=3,485). Fig Survival of dialysis patient with underlying glomerulonephritis according to dialysis modalities since 2001 (HD : n=3,295 PD : n=877). Fig Survival of dialysis patient with underlying hypertensive sclerosis according to dialysis modalities since 2001 (HD : n=6,438, PD : n=1,703). Fig Survival of dialysis patient with miscellaneous underlying diseases according to dialysis modalities since 2001 (HD : n=7,891, PD : n=1,817). Part 9. Kidney Transplantation Fig.9-1. Annual number of kidney transplantation in Korea (including data from KONOS: Korean Network for Organ Sharing). * Survived KT waiting patient number at the end of each year. ======================================================================================================= Acknowledgements : We, ESRD registry committee of Korean Society of Nephrology, would like deeply thank to every dialysis center medical doctors and nurses in Korea for participation in this survey. Gambro Korea, FMC Korea, Baxter Korea and Boryung Pharm were also share their data for confirmation.
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