September 29, 2004 - Click here to go directly to the USRDS Year 2004 report.
The United States Renal Data System (USRDS) is a national data system which collects, analyzes, and distributes information about end-stage renal disease (ESRD) in the United States. The USRDS is funded directly by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in conjunction with the Centers for Medicare and Medicaid Services (CMS). The USRDS Coordinating Center is operated under a contract with the Minneapolis Medical Research Foundation.
Most of the 2004 Annual Data Report (ADR) contains data through December 31, 2002.
An excerpt from the Treatment Modalities section of the report:
"In 2002, 91,049 patients initiated ESRD therapy on hemodialysis and 6,648 on peritoneal dialysis, while 2,046 patients began ESRD therapy with a renal transplant. From 1998 to 2002, incident rates for hemodialysis increased 1.9 percent per year, and rates of transplant as the initial ESRD modality grew 6.7 percent; rates for peritoneal dialysis, in contrast, fell almost 4.5 percent.
The prevalent ESRD population includes 281,594 patients on hemodialysis (65 percent), 122,374 with a functioning renal transplant (28 percent), and 24,531 on peritoneal dialysis (6 percent, equally split between CAPD and CCPD). Ninety-two percent of dialysis patients are treated with hemodialysis and 8 percent with peritoneal dialysis. Between 1998 and 2002 the prevalent hemodialysis and transplant populations grew 3.2 and 4.3 percent per year, while the peritoneal dialysis population decreased almost 3.5 percent per year."
"As in the incident population, dramatic changes continue to occur in the insurance coverage of prevalent patients. After serving as the sole insurer for 93.6 percent of prevalent hemodialysis patients in 1978, for example, in 2002 Medicare was the sole insurer for only 43.5 percent. Medicare and Medicaid together now cover almost one-third of these patients, and HMOs an additional 5.5 percent. Medicare HMO coverage has declined in recent years, as health plans choose not to participate in the Medicare+Choice managed care payment system. Compared to hemodialysis patients, fewer patients on transplant are covered solely by Medicare, Medicare plus Medicaid, or a Medicare HMO.
Diabetes is the primary diagnosis in 45 percent of incident hemodialysis patients, compared to 43.3 percent of those on peritoneal dialysis or other therapies; among prevalent patients the numbers are 42 and 35.2 percent, respectively. Differences in diabetes rates between the two populations are caused by higher death rates among diabetics.
The racial distribution of patients by modality is affected by access to care. The proportion of incident black patients treated with a transplant, for example, has declined over the past quarter century, a reflection of longer waiting times and lower donation rates in the black population.
New analyses this year examine the probability of a patient changing modality. The cumulative probability of dying in the first five years of treatment is highest for hemodialysis patients and lowest for those on peritoneal dialysis. Much of this difference is secondary to the effect of age; in patients age 20�44, for example, the probability of death for peritoneal dialysis patients is lower than that for hemodialysis patients, while in other age groups the probabilities are comparable. A peritoneal dialysis patient with diabetes is almost ten times more likely to change to hemodialysis than a hemodialysis patient is to change to peritoneal dialysis, and 2.5 times more likely to receive a renal transplant.
Chain-owned facilities continue to dominate the dialysis provider system, absorbing nearly all patient growth. In independent and hospital-based units, the hemodialysis population remains relatively stable, while the peritoneal dialysis population has declined. The four largest dialysis chains account for 52�57 percent of the incident and prevalent dialysis populations under treatment."
Here is a small sampling of the statistics available in the report. These facts apply to the U.S. end-stage renal disease (ESRD) population as of December 31, 2002 (Source is Table D1):
There were 308,910 dialysis patients, rising from 2001's total of 296,864.
There were 122,374 patients with functioning transplanted kidneys, up from 115,351 in 2001.
90.7 percent of all dialysis patients were receiving in-center hemodialysis treatments (280,167 patients). This has risen since 1984, when 76.2 percent of dialysis patients were on in-center hemodialysis.
There were 1243 patients on home hemodialysis. This number represents only 0.4 percent of all dialysis patients.
There are a decreasing number of CAPD patients. The number of CAPD (continuous ambulatory peritoneal dialysis) patients dropped from 12,175 in 2001 to 10,937 in 2001. CAPD patients make up 3.5 percent of the dialysis patient population. This has dropped steadily since 1990, when 12.4 percent of patients were on CAPD.
There was a small increase in the number of CCPD patients. The number of CCPD (continuous cycling peritoneal dialysis) patients rose from 12,482 in 2001 to 13,594 in 2002. 4.4 percent of dialysis patients are on CCPD.
Black patients still lag far behind white patients in kidney transplants (From Table D3):
There were 172,502 white dialysis patients, comprising 55.8 percent of the total.
There were 113,632 black dialysis patients, comprising 36.8 percent of the total.
There were 93,761 white patients with functioning kidney transplants, comprising 76.6 percent of the "functioning graft" patients.
There were 21,503 black patients with functioning kidney transplants, comprising only 17.6 percent of the "functioning graft" patients.
