Global variation in renal replacement therapy for end-stage renal disease

Fergus J Caskey, Anneke Kramer, Robert F Elliott, Vianda S Stel, Adrian Covic, Ana Cusumano, Claudia Geue, Alison M Macleod, Aeilko H Zwinderman, Benedicte Stengel, Kitty J Jager

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Abstract

BACKGROUND: Incidence rates of renal replacement therapy (RRT) for end-stage renal disease vary considerably worldwide. This study examines the independent association between the general population, health care system and renal service characteristics and RRT incidence rates. METHODS: RRT incidence data (2003-2005) were obtained from renal registries; general population age and health and macroeconomic indices were collected from secondary sources. Renal service organization and resource data were obtained through interviews and questionnaires. Linear regression models were built to establish the factors independently associated with RRT incidence, stratified by the Human Development Index where required. False discovery rate (FDR) correction was adjusted for multiple testing. RESULTS: Across the 46 countries (population 1.25 billion), RRT incidence rates ranged from 12 to 455 (median 130) per million population. Gross domestic product (GDP) per capita [incidence rate ratio (IRR): 1.02 per $1000 increase, P(FDR) = 0.047], percentage of GDP spent on health care (IRR: 1.11 per % increase, P(FDR) = 0.006) and dialysis facility reimbursement rate relative to GDP (IRR: 0.76 per GDP per capita-sized increase in reimbursement rate, P(FDR) = 0.007) were independently associated with RRT incidence. In more developed countries, the private for-profit share of haemodialysis facilities was also associated with higher incidence (IRR: 1.009 per % increase, P(FDR) = 0.003). CONCLUSIONS: Macroeconomic and renal service factors are more often associated with RRT incidence rates than measured demographic or general population health status factors.
Original languageEnglish
Pages (from-to)2604-2610
Number of pages7
JournalNephrology Dialysis Transplantation
Volume26
Issue number8
Early online date18 Jan 2011
DOIs
Publication statusPublished - Aug 2011

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Renal Replacement Therapy
Chronic Kidney Failure
Incidence
Gross Domestic Product
Kidney
Population
Linear Models
Delivery of Health Care
Human Development
Developed Countries
Health Status
Registries
Renal Dialysis
Dialysis
Demography
Organizations

Keywords

  • epidemiology
  • health policy
  • macroeconomics
  • renal replacement therapy

Cite this

Caskey, F. J., Kramer, A., Elliott, R. F., Stel, V. S., Covic, A., Cusumano, A., ... Jager, K. J. (2011). Global variation in renal replacement therapy for end-stage renal disease. Nephrology Dialysis Transplantation, 26(8), 2604-2610. https://doi.org/10.1093/ndt/gfq781

Global variation in renal replacement therapy for end-stage renal disease. / Caskey, Fergus J; Kramer, Anneke; Elliott, Robert F; Stel, Vianda S; Covic, Adrian; Cusumano, Ana; Geue, Claudia; Macleod, Alison M; Zwinderman, Aeilko H; Stengel, Benedicte; Jager, Kitty J.

In: Nephrology Dialysis Transplantation, Vol. 26, No. 8, 08.2011, p. 2604-2610.

Research output: Contribution to journalArticle

Caskey, FJ, Kramer, A, Elliott, RF, Stel, VS, Covic, A, Cusumano, A, Geue, C, Macleod, AM, Zwinderman, AH, Stengel, B & Jager, KJ 2011, 'Global variation in renal replacement therapy for end-stage renal disease', Nephrology Dialysis Transplantation, vol. 26, no. 8, pp. 2604-2610. https://doi.org/10.1093/ndt/gfq781
Caskey FJ, Kramer A, Elliott RF, Stel VS, Covic A, Cusumano A et al. Global variation in renal replacement therapy for end-stage renal disease. Nephrology Dialysis Transplantation. 2011 Aug;26(8):2604-2610. https://doi.org/10.1093/ndt/gfq781
Caskey, Fergus J ; Kramer, Anneke ; Elliott, Robert F ; Stel, Vianda S ; Covic, Adrian ; Cusumano, Ana ; Geue, Claudia ; Macleod, Alison M ; Zwinderman, Aeilko H ; Stengel, Benedicte ; Jager, Kitty J. / Global variation in renal replacement therapy for end-stage renal disease. In: Nephrology Dialysis Transplantation. 2011 ; Vol. 26, No. 8. pp. 2604-2610.
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abstract = "BACKGROUND: Incidence rates of renal replacement therapy (RRT) for end-stage renal disease vary considerably worldwide. This study examines the independent association between the general population, health care system and renal service characteristics and RRT incidence rates. METHODS: RRT incidence data (2003-2005) were obtained from renal registries; general population age and health and macroeconomic indices were collected from secondary sources. Renal service organization and resource data were obtained through interviews and questionnaires. Linear regression models were built to establish the factors independently associated with RRT incidence, stratified by the Human Development Index where required. False discovery rate (FDR) correction was adjusted for multiple testing. RESULTS: Across the 46 countries (population 1.25 billion), RRT incidence rates ranged from 12 to 455 (median 130) per million population. Gross domestic product (GDP) per capita [incidence rate ratio (IRR): 1.02 per $1000 increase, P(FDR) = 0.047], percentage of GDP spent on health care (IRR: 1.11 per {\%} increase, P(FDR) = 0.006) and dialysis facility reimbursement rate relative to GDP (IRR: 0.76 per GDP per capita-sized increase in reimbursement rate, P(FDR) = 0.007) were independently associated with RRT incidence. In more developed countries, the private for-profit share of haemodialysis facilities was also associated with higher incidence (IRR: 1.009 per {\%} increase, P(FDR) = 0.003). CONCLUSIONS: Macroeconomic and renal service factors are more often associated with RRT incidence rates than measured demographic or general population health status factors.",
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AU - Cusumano, Ana

AU - Geue, Claudia

AU - Macleod, Alison M

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N2 - BACKGROUND: Incidence rates of renal replacement therapy (RRT) for end-stage renal disease vary considerably worldwide. This study examines the independent association between the general population, health care system and renal service characteristics and RRT incidence rates. METHODS: RRT incidence data (2003-2005) were obtained from renal registries; general population age and health and macroeconomic indices were collected from secondary sources. Renal service organization and resource data were obtained through interviews and questionnaires. Linear regression models were built to establish the factors independently associated with RRT incidence, stratified by the Human Development Index where required. False discovery rate (FDR) correction was adjusted for multiple testing. RESULTS: Across the 46 countries (population 1.25 billion), RRT incidence rates ranged from 12 to 455 (median 130) per million population. Gross domestic product (GDP) per capita [incidence rate ratio (IRR): 1.02 per $1000 increase, P(FDR) = 0.047], percentage of GDP spent on health care (IRR: 1.11 per % increase, P(FDR) = 0.006) and dialysis facility reimbursement rate relative to GDP (IRR: 0.76 per GDP per capita-sized increase in reimbursement rate, P(FDR) = 0.007) were independently associated with RRT incidence. In more developed countries, the private for-profit share of haemodialysis facilities was also associated with higher incidence (IRR: 1.009 per % increase, P(FDR) = 0.003). CONCLUSIONS: Macroeconomic and renal service factors are more often associated with RRT incidence rates than measured demographic or general population health status factors.

AB - BACKGROUND: Incidence rates of renal replacement therapy (RRT) for end-stage renal disease vary considerably worldwide. This study examines the independent association between the general population, health care system and renal service characteristics and RRT incidence rates. METHODS: RRT incidence data (2003-2005) were obtained from renal registries; general population age and health and macroeconomic indices were collected from secondary sources. Renal service organization and resource data were obtained through interviews and questionnaires. Linear regression models were built to establish the factors independently associated with RRT incidence, stratified by the Human Development Index where required. False discovery rate (FDR) correction was adjusted for multiple testing. RESULTS: Across the 46 countries (population 1.25 billion), RRT incidence rates ranged from 12 to 455 (median 130) per million population. Gross domestic product (GDP) per capita [incidence rate ratio (IRR): 1.02 per $1000 increase, P(FDR) = 0.047], percentage of GDP spent on health care (IRR: 1.11 per % increase, P(FDR) = 0.006) and dialysis facility reimbursement rate relative to GDP (IRR: 0.76 per GDP per capita-sized increase in reimbursement rate, P(FDR) = 0.007) were independently associated with RRT incidence. In more developed countries, the private for-profit share of haemodialysis facilities was also associated with higher incidence (IRR: 1.009 per % increase, P(FDR) = 0.003). CONCLUSIONS: Macroeconomic and renal service factors are more often associated with RRT incidence rates than measured demographic or general population health status factors.

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