THE BLOG

How the United States Stacks Up to Other Countries in Chronic Kidney Disease

03/11/2015 04:32 pm ET | Updated May 11, 2015
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Patients sometimes tell me in research interviews that they intentionally compare themselves to other patients who are worse off to make themselves feel better. Comparing ourselves to others who may be better or worse off can give us ideas for improving our own health.

Similarly, the United States should compare itself to other countries to improve our health outcomes. In the case of kidney disease, World Kidney Day on March 12 draws our attention to international comparisons of health.

Chronic kidney disease is a growing public health problem in this country and around the world. So it is important for all countries to prevent chronic kidney disease and its progression to the point where kidneys fail, called end-stage kidney disease.

Besides advocating prevention, the International Society of Nephrology and the International Federation of Kidney Foundations, are sponsoring World Kidney Day to also spread the word that, "We are not all equal with regard to kidney disease and access to treatment."

Understanding how and where such inequalities occur is crucial to changing them, and the best way to identify inequalities is through comparison.

According to the United States Renal Data System 2014 Annual Data Report, which compared 54 countries, the United States does not fare well in terms of the prevalence of end-stage kidney disease, which was 1,976 per million population in 2012. But Taiwan and Japan fared even worse at 2,902 and 2,365, respectively.

What this means is that the United States has the third highest prevalence of end-stage kidney disease. While zero prevalence should be everyone's ideal target, a realistic goal should be prevalence that first world countries have already attained. For instance, Hungary and Iceland have a prevalence of end-stage kidney disease at 633 and 683 per million population, respectively.

Many Americans probably don't realize that the United States fares so poorly compared to other first world countries in chronic kidney disease. Given that we're one of the wealthiest countries in the world, I'm sure many people wonder, why is this happening?

Some factors contributing to chronic kidney disease include the rise in diabetes and hypertension (the largest risk factors), and the growing overweight and aging population.

Comparison affords new insights into health care practices or policies in the United States that we had ordinarily taken for granted and presumed to be 'natural' or thus not changeable. Newfound insights can open the door to reconsidering factors that contribute to those health care practices and policies that may serve as a barrier or enabler to our standards of care.

For patients with end-stage kidney disease, kidney transplantation is the optimal treatment over dialysis because kidney recipients survive longer and have a better quality of life. But because so many more people have end-stage kidney disease than there are kidney donors available, it's harder and harder for people to get a kidney transplant in the United States and internationally.

In the United States, the kidney transplant rate was 55 per million population in 2012. This rate does not look encouraging in consideration of the disproportionately high number of patients with end-stage kidney disease, however, we rank fourth in kidney transplants. That's pretty good, but not as good as Norway, Jalisco (Mexico), and The Netherlands, which surpass us at 60, 59, and 57 kidney transplants per million population, respectively, according to the United States Renal Data System 2014 Annual Data Report.

The 2013 deceased donor rate in the United States was 25.8 per million population, but in Spain, which has the highest rate in the world, it was 35.3 per million.

In this case, such comparisons can be humbling but they lead to important questions. What are other countries like Hungary, Norway, and Spain doing that we're not doing? What can we do to make things better for patients in the United States? And, are there cultural values, policies, or health care system practices that make a difference?

Many transplant researchers have looked into Spain's high deceased donation rates and found, for example, that the number of older donors in Spain is much greater than it is in the United States, as reported in the journal, Liver Transplantation.

This suggests that we should be pursuing avenues for intervention such as educational programs to increase public awareness particularly among older citizens about the option of registering on the State Organ and Tissue Donor Registries or checking their driver's licenses to indicate willingness to become deceased donors.

Additionally, Spain's success has been attributed largely to their Organización Nacional de Trasplantes, which is a national organizational infrastructure for transplantation, distinguished by extensive coordination among its transplant coordinators across the country and collaboration with the media to educate and foster public trust in organ donation. No wonder other countries like the United Kingdom are seeking to emulate the Spanish system.

The United States could benefit by learning from Spain - greater public education could help to further dispel the many myths and misconceptions that the public holds about transplantation that inhibit people from registering to be deceased donors or from becoming living donors.

By inspiring international comparisons, World Kidney Day fosters greater knowledge about chronic kidney disease and reveals possible ways we can improve patient health. And that is good news for everyone.

Elisa Gordon, Ph.D., M.P.H. is Associate Professor in the Comprehensive Transplant Center at Northwestern University Feinberg School of Medicine