In your state? In your country? In the world? Let’s go for the big one. How many BigD members are there on our fair planet?
First, some definitions: the term for anyone receiving any kind of therapy for End Stage Renal Failure is called Renal Replacement Therapy or RRT. So, all of us who have functioning kidney transplants, or on haemodialysis or peritoneal dialysis are on RRT. The best way to work out how many people are actually on RRT is to look at the countries that measure and analyse their RRT numbers and extrapolate.
For example, in Australia and NZ, the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) collects a wide range of statistics which relate to the outcomes of treatment of those with end stage renal failure. They produce a detailed report each year broken down by age and sex (a common problem) and anything else you can imagine. Part of their summary states:
- In Australia, there were 16,751 people (797 per million) receiving renal replacement therapy (RRT) at 31st December 2007. Of these, 7,109 (338 per million) had a functioning kidney transplant and 9,642 (459 per million) received dialysis treatment.
- In New Zealand, there were 3,353 people (793 per million) receiving renal replacement therapy (RRT) at 31st December 2007. Of these, 1,289 (305 per million) had a functioning kidney transplant, and 2,064 (488 per million) received dialysis treatment.
In Canada, the Canadian Institute for Health Information provides a range of aggregate-level data on dialysis and transplants. However, the day I chose to check it out, it was down “upgrading content and functionality”. The most recent report I could find was dated 2004. However I suspect that the numbers are similar to those in Australia.
In the US, the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), which is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which in turn is part of the National Institutes of Health of the U.S. Department of Health and Human Services, produces an excellent annual report. From the summary page:
- Prevalence (2006): 506,256 U.S. residents were under (RRT) treatment as of the end of the calendar year
- Cost for the ESRD program (2006): $33.61 billion in public and private spending
- Dialysis treatment (2006): 354,754 U.S. residents with ESRD received dialysis:
- In-center hemodialysis: 325,299
- Home hemodialysis: 2,455
- Peritoneal dialysis: 26,114
- There were 45,484 adult patients receiving RRT on 31/12/2007. The population prevalence for adults was 746 per million population per year (pmp) with an annual increase in prevalence of approximately 5% per annum.
- The most common treatment modality was transplantation (21,196 – 46.6%), closely followed by centre-based HD (19,149 – 42.1%) in either the primary centre (25.2%) or the satellite unit (16.9%). The HD population has continued to expand, and the PD population to contract.
For all European RRT data, the European Renal Association – European Dialysis and Transplant Association (ERA -EDTA) produces an excellent annual report. Roughly, there are approximately 260,000 people on dialysis and there were about 8000 transplants conducted throughout Europe in 2007. See the above report for by country and demographic listings.
(Note the low number of transplants in Australia and New Zealand compared to most other countries. This is due to a very poor level of organ donation in ANZ. They have an Opt-in system (you must formally nominate to be an organ donor), where many other countries have an Opt-out system (where you must formally nominate NOT to be an organ donor). This and a secret fear that “they might take me before I”m dead” keeps the transplant wait time at 5 – 10 years.)
After this it gets a little rubbery. Time for calculations. If you look at the average per million people (pmp) figures for the above countries, and you use this to extrapolate for countries in Asia, Africa, Eastern Europe, South America and the Middle East, etc. (it’s done very badly here, but it’s a good list of countries) my best estimate for the number of people on the Big D is between 4 and 5 million people.
So united we could form a small country, but it would need a serious health care budget.