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Growth of The ESKD Population Progress or Peril .3
Growth of The ESKD Population Progress or Peril .3
org EDITORIALS
Growth of the ESKD Population: over time as seen with the recent increase in available organs
resulting from opiate overdoses, leading to higher transplanta-
Progress or Peril? tion rates.3 Relatively healthy patients with ESRD on the wait-
ing list for a transplant accumulate on dialysis, which leads to
Allan J. Collins lower overall death rates.
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School of Medicine, University of Minnesota, Minneapolis, Minnesota Growth in the ESRD population has not been accompanied
by a comparable growth in the number of organs available for
J Am Soc Nephrol 30: 3–4, 2019.
doi: https://doi.org/10.1681/ASN.2018111135 transplant. Between 2004 and 2014, the number of kidney
transplants increased only 5% from 17,148 to 17,998.4 The
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mortality and incidence on the basis of the most recent Bethesda, MD, National Institutes of Health, National Institute of Di-
year’s data. This approach also overestimated the incident abetes and Digestive and Kidney Diseases, 2018. Available at: https://
www.usrds.org/reference.aspx. Accessed October 25, 2018
population but was within 10% for the prevalent popula- 8. US Renal Data System: Reference table D.6. In: 2018 USRDS Annual
tion, erring on the high side by assuming falling death rates Data Report: Epidemiology of Kidney Disease in the United States,
in the dialysis population. Bethesda, MD, National Institutes of Health, National Institute of Di-
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The lower end of the projection by McCullough et al.2 may abetes and Digestive and Kidney Diseases, 2018. Available at: https://
be too conservative, because the incident 90-day death rates www.usrds.org/reference.aspx. Accessed October 25, 2018
9. Xue JL, Ma JZ, Louis TA, Collins AJ: Forecast of the number of patients
given in the US Renal Data System 2018 Annual Data Report with end-stage renal disease in the United States to the year 2010. J Am
show a decline.11 As noted above, the upper end projection of Soc Nephrol 12: 2753–2758, 2001
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1,259,000 does not consider the effect of the two basic modal- 10. Gilbertson DT, Liu J, Xue JL, Louis TA, Solid CA, Ebben JP, et al.:
ities of kidney transplantation and dialysis. Because the Projecting the number of patients with end-stage renal disease in the
authors did not use an integrated approach to project these United States to the year 2015. J Am Soc Nephrol 16: 3736–3741, 2005
11. US Renal Data System: Healthy people 2020. In: 2018 USRDS Annual Data
populations, it is difficult to assess the inter-related issues of Report: Epidemiology of Kidney Disease in the United States, Bethesda,
access to organs—which drives growth in the transplant pop- MD, National Institutes of Health, National Institute of Diabetes and Di-
ulation and removes healthy patients from the dialysis pool— gestive and Kidney Diseases, 2018. Available at: https://www.usrds.org/
and changing death rates in the prevalent dialysis population. 2018/view/Default.aspx. Accessed October 25, 2018
It is important to acknowledge the inevitable uncertainties
in 15-year projections. Ongoing efforts to prevent kidney dis-
ease and slow its progression may start to have an effect. See related article, “Projecting ESRD Incidence and Prevalence in the United
Changes in organ availability and death rates will certainly States through 2030,” on pages 127–135.
have an important influence. Future models should build
in a range of estimates of these possible changes. This would
allow for greater clarity of the realities facing patients and
providers today.
Postoperative AKI—Prevention
Is Better than Cure?
DISCLOSURES
A.J.C. served as Director of the US Renal Data System from 1999 to 2014 Samira Bell1,2 and John Prowle3,4
1
when the prior two projections were published. A.J.C. is currently the Chief Renal Unit, Ninewells Hospital, Dundee, United Kingdom; 2Division
Medical Officer of NxStage Medical, Inc., a home hemodialysis and acute of Population Health Science and Genomics, School of Medicine,
dialysis product company. University of Dundee, Dundee, United Kingdom; 3Adult Critical Care
Unit and Department of Renal Medicine and Transplantation, The
Royal London Hospital, Barts Health National Health Service Trust,
London, United Kingdom; and 4William Harvey Research Institute,
REFERENCES Queen Mary University of London, London, United Kingdom
1. US Renal Data System: Reference tables D.6 and D.9. In: 2018 USRDS J Am Soc Nephrol 30: 4–6, 2019.
Annual Data Report: Epidemiology of Kidney Disease in the United doi: https://doi.org/10.1681/ASN.2018111127
States, Bethesda, MD, National Institutes of Health, National In-
stitute of Diabetes and Digestive and Kidney Diseases, 2018. Avail-
able at: https://www.usrds.org/reference.aspx. Accessed October 25, AKI could be considered as a sentinel postoperative compli-
2018
cation, because it is relatively common and strongly associated
2. McCullough KP, Morgenstern H, Saran R, Herman WH, Robinson BM:
Projecting ESRD incidence and prevalence in the United States with increased short- and long-term risk of death, the devel-
through 2030. J Am Soc Nephrol 30: 127–135, 2019 opment of other postoperative complications, increased length
3. Mehra MR, Jarcho JA, Cherikh W, Vaduganathan M, Lehman RR, of hospital stay, and potentially, the development of progressive
Smits J, et al.: The drug-intoxication epidemic and solid-organ CKD.1 Consequently, patients with AKI after surgery are an
transplantation. N Engl J Med 378: 1943–1945, 2018
area of unmet clinical need and a major burden on health care
4. US Renal Data System: Reference tables E.3 and E.6. In: 2018 USRDS
Annual Data Report: Epidemiology of Kidney Disease in the United resources. In the absence of effective interventions to treat
States, Bethesda, MD, National Institutes of Health, National Institute established AKI, preoperative identification of patients at
of Diabetes and Digestive and Kidney Diseases, 2018. Available at: high risk of AKI allows for perioperative optimization to pre-
https://www.usrds.org/reference.aspx. Accessed October 25, 2018 vent or reduce the severity of AKI. A number of large
5. Wetmore JB, Liu J, Li S, Hu Y, Peng Y, Gilbertson DT, et al.: The Healthy
People 2020 objectives for kidney disease: How far have we come, and
where do we need to go? Clin J Am Soc Nephrol 12: 200–209, 2017
6. NCD Countdown 2030 collaborators: NCD Countdown 2030: World- Published online ahead of print. Publication date available at www.jasn.org.
wide trends in non-communicable disease mortality and progress
Correspondence: Dr. Samira Bell, Division of Population Health Science and
towards Sustainable Development Goal target 3.4. Lancet 392: 1072–
Genomics, School of Medicine, University of Dundee, Mackenzie Building, Kirsty
1088, 2018
Semple Way, Dundee DD2 4BF, United Kingdom. Email: Samira.bell@nhs.net
7. US Renal Data System: Reference table H.4. In: 2018 USRDS Annual
Data Report: Epidemiology of Kidney Disease in the United States, Copyright © 2019 by the American Society of Nephrology
4 Journal of the American Society of Nephrology J Am Soc Nephrol 30: 1–6, 2019