Prevalence
Many countries have surveillance programmes to
monitor kidney failure treated by dialysis and
transplantation
(fi gure 3).
26
Incidence and prevalence
vary because of diff erences in underlying diseases rates
and availability of government-sponsored treatment.
Incidence is now as high as 200 cases per million per
year in many countries. It is nearing 400 cases per
million in the USA, Taiwan, and some regions in
Mexico, and has risen fastest in older individuals.
Dialysis is the main treatment method in most
countries. With average survival of 3–5 years in the
USA, prevalence is nearing 1800 cases per million. In
Japan and Taiwan, high survival translates to high
prevalence nearing 2400 cases per million. Diabetes is
the main cause of kidney failure in most countries,
accounting for 40% or more of new patients.
26
The USA
has a high incidence of disease in racial and ethnic
minorities, which is probably an indicator of genetic
and environmental factors in susceptibility, and
disparities in treatment.
25,27,28
Estimation of the burden of early stages of kidney
disease is diffi
cult. Prevalence estimates might be biased
by limitation of the markers and methods that are used
to estimate GFR and to defi ne kidney damage. In the
USA, the most accurate estimates based on estimated
GFR and albuminuria of the prevalence of chronic kidney
Normal
Screening
for CKD
risk factors
Increased
risk
CKD risk
reduction;
screening for
CKD
Damage
Diagnosis and
treatment;
treat comorbid
conditions;
slow progression
↓ GFR
Estimate
progression;
treat complications;
prepare for
replacement
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