Keto Acid Therapy in CKD Patients Epidemiology of CKD Worldwide

s Am J Nephrol 2005;25(suppl 1):1–28 7 surveys and continuous patient data recording since 1996. On 31 December 2001, 1,164 facilities for dialysis and renal transplantation treatment were reported to the QuaSi-Niere-GmbH. The longitudinal data of more than 85,000 patients are available (diagnosis, modality, morbidity, follow-up). Concerning the worldwide end-stage renal disease (ESRD) population including more than 230 countries (population: 6.3 billion), 122 countries have reported that they provide dialysis care to patients with renal failure (population: 5.8 billion) (fig. 1). Countries where renal replacement therapy (RRT) has become standard therapy include USA, Japan, Germany, Brazil and Italy. The values for the prevalence of RRT differ between the countries (fig. 2). In 2000/2001, the highest values for the prevalence of RRT are in Japan, USA and Germany, ranging from 1,722 patients per million population (pmp) in Japan to 919 pmp in Germany, the lowest values are in UK, Finland, Norway, Australia and Netherlands (566 to 640 pmp). The same proportion can be seen regarding the incidence of RRT (fig. 2). In general, the prevalence as well as the incidence of RRT have increased over the years from 1994 to 2000/ 2001 and they correlate with the wealth of the country. A comparison of the national economic strength (expressed as gross domestic product (GDP)) with the prevalence of ESRD suggests that economic factors may impose restrictions on treatment. Restriction of dialysis treatment is suggested in countries in which the gross domestic product per capita is below a limiting value. This correlation does not seem to be valid for countries in the European Union. In highly-developed countries there are three different kinds of health care models: (1) Beveridge model: national health service (e.g. UK, Spain, Italy, Scandinavia, Canada, Australia), (2) Private model: insurance (USA), (3) Bismarck model: national health service plus insurance (e.g. Germany, France, Belgium, Switzerland, Netherlands, Austria, Japan). In 2001, the expenditure for health (expressed as % GDP) ranges from 7 to 14% GDP, whereas the highest costs are in the private model (USA: 14%). In future, the total expenditure on health will increase dramatically, based on findings for the period between 1994 and 2001. Three other aspects should be noted: (1) The increasing healthy life expectancy (in 2001 approximately 68 years for male and 72 years for female). (2) The increasing median age of patients on dialysis. (3) The exponential growth of diabetic nephropathy as a cause of ESRD. Dietary Therapy in CKD Patients – The Current Status