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A Transatlantic comparison in CKD care

A Transatlantic comparison in CKD care

Session: Global Challenges of CKD

Sub-session: CKD in the United States and Europe: Juxtaposing the Epidemiology and Evolution

Presenter: Kitty J. Jager, MD, PhD, Academic Medical Center

There are marked differences in chronic kidney disease (CKD) prevalence and incidence trends between the Unites States and Europe. Even within countries there are enormous disparities.

During a deep dive into the granularity of available data, Kitty J. Jager, MD, PhD, Academic Medical Center, pointed out how, where, and sometimes why such differences in prevalence and incidence of CKD exist. Identifying and interpreting this data, Dr. Jager suggested, is critical to reducing the burden of CKD.

To begin at the beginning, Dr. Jager explained the separation between specific risk factors of CKD in the US and Europe.

  • Diabetes prevalence in the general population is higher in the US than in most European countries, and it is rising at a faster rate in the US.
  • Not only is the percentage of obesity in the US increasing but so is the percentage of obese people with diabetes.
  • With respect to Europe, Portugal and Turkey have a diabetes prevalence similar to — and sometimes even higher than — the United States.
  • In sharp contrast, blood pressure levels in the US are lower than in Europe — both in the general population and CKD patients.
  • Turning to drug prescriptions, data suggest that antihypertensives are more aggressively prescribed for CDK in the US. On the other hand, renin-angiotensin-aldosterone system (RAAS) inhibitors are prescribed more often in Europe.

With respect to the prevalence of CKD in Europe vs. the United States, Dr. Jager drove home several points.

  • The prevalence of CKD is higher in the US than Europe. However, there is a bright spot — with US diabetic patients age adjusted stage 1 through 5 prevalence decreasing.
  • In the US and Europe the CKD prevalence due to diabetes is increasing. On a far more positive note, hypertension and glomerulonephritis (GN) is decreasing, which is helping to reduce CKD prevalence.
  • In a number of countries — where information exists — overall age-adjusted CKD prevalence has stabilized.
  • Given its social demographic index, according to the Global Burden of Disease, the US is among three countries in the United States/Europe comparison that has the largest unrealized opportunity for improvement of CKD dialysis. This is based on the United States’ place on the development spectrum.
  • There is, however, a huge variation in opportunity for improvement of CKD dialysis across different states.

Looking at the United States and Europe, Dr. Jager described contrasts in renal replacement therapy (RRT).

  • In Europe, there is a much lower incidence rate of RRT than in the US — even when comparing Europe to US white populations.
  • The unadjusted incidence of RRT in the US and Europe is increasing. Fortunately, adjusted incidence has stabilized.
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