- Nearly 750,000 patients per year in the United States and an estimated 2 million patients worldwide are affected by end stage renal disease (ESRD).
- ESRD is increasing in the United States by 5% per year.
- Those who live with ESRD are 1% of the U.S. Medicare population but account for 7% of the Medicare budget.
- More than 100,000 patients in the United States are on the kidney transplant list, but last year there were just over 21,000 donor organs available for transplant.
- The need for donor kidneys in the United States is rising at 8% per year.
End stage renal disease affects almost 750,000 people per year in the United States. The disease disproportionately affects the nation’s minority and low-income patients. Compared to whites:
- African Americans are 3.5 times more likely to have ESRD.
- Native Americans are 1.5 times more likely to have ESRD.
- Hispanics are 1.5 times more likely to have ESRD.
The number of patients in the United States diagnosed with ESRD is increasing by 5% each year. Mortality rates vary depending on the ESRD treatment. After one year of treatment, those on dialysis have a 20-25% mortality rate, with a 5-year survival rate of 35%. Persons who receive transplants have a 3% mortality rate after 5 years.
Internationally the numbers are staggering. Estimates are that 2 million people worldwide suffer from ESRD, and the number of patients diagnosed with the disease continues to increase at a rate of 5-7% per year. Taiwan, Japan, Mexico, the United States, and Belgium currently have the highest prevalence of ESRD. And while extensive data on worldwide mortality rates is lacking, a 2007 report shows that U.S. mortality risk was 15% higher than in Europe and 33% higher than in Japan on comparable treatment modalities.
At present, ESRD patients have two treatment options:
- Transplantation: live and deceased donor kidneys
- Dialysis: hemodialysis or peritoneal dialysis
The best current treatment for ESRD is kidney transplantation, which requires a donor match, major surgery, and a lifetime regimen of immunosuppressant medications to prevent rejection. For those ESRD patients able to receive a kidney transplant, the outlook is positive; the five-year survival rate for transplant recipients is over 80%. But:
- There is an acute shortage of donor organs for ESRD patients. There are more than 100,000 ESRD patients on the U.S. transplant wait list. In 2016, 20,161 kidney transplants were performed in the United States.
- The need for donor kidneys is rising at 8% per year, yet their availability has not grown to match.
- The transplanted live kidney is treated by the body as a foreign object and, as a result, the patient must take immunosuppressants for the life of the transplant. These drugs can have numerous side effects. And because immunosuppressants block the immune system, the transplant recipient is at a greater risk for infections and cancers. The patient’s own immune system is the single largest challenge to the success of a kidney transplant when the donor and recipient are not genetically identical.
The only alternative today to kidney transplantation is dialysis.
- Hemodialysis involves pumping a patient’s blood through an external circuit for filtration before it is pumped back into the body. A typical hemodialysis schedule is three sessions per week, for 3-5 hours per session at a medical facility.
- Peritoneal dialysis uses the patient’s own abdomen across which waste is exchanged from the blood and flushed out regularly through a permanent tube in the abdomen. Peritoneal dialysis does not require regular trips to a medical facility but still requires regular treatment at home.
Hemodialysis is the far more common type of dialysis—about 90% of all dialysis patients.
While effective in the short term, hemodialysis has drawbacks:
- It is confining and inconvenient; patients are tethered to a machine for three- to four-hour sessions in a clinic three times per week.
- Dialysis is exhausting for patients and fraught with morbidity and eventual mortality. 35% of hemodialysis patients remain alive after five years of treatment.
Medicare coverage is extended to a person of any age who requires either dialysis or transplantation to maintain life. The almost 750,000 people who live with ESRD are 1% of the U.S. Medicare population but account for roughly 7% of the Medicare budget.
- Hemodialysis treatment costs an average of $89,000 per patient annually in the United States. This amounts to a total annual hemodialysis cost in the United States of $42 billion; $34 billion of this is absorbed through the Medicare budget. The remainder is either covered by Medicaid, private insurance, or paid out of pocket.
- The average cost of a kidney transplant is $32,000 for the transplant surgery and $25,000 per year post-surgery to care for the patient and ensure the transplant is not rejected. 53% of the total annual transplant cost in the United States is absorbed through the Medicare budget. Again, the remainder is either covered by Medicaid, private insurance, or paid out of pocket.
- The Kidney Project will save the Medicare budget $15 billion annually once the bioartificial kidney is available to eligible patients who are on dialysis or unable to get a transplant.
U.S. Renal Data System, USRDS 2018 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.