Article Figures & Data
Figures
- Figure 1.
Selected characteristics related to dialysis treatment (all modalities) for Canada and the United States. Sources: (A) the United States Renal Data System (USRDS) (70). (B) The USRDS (70) and the Canadian Organ Replacement Register (CORR) (23). (A) Comparison of the prevalence of dialysis treatment in Canada and the United States per million population. It shows that the prevalence of ESKD has been consistently higher over time in the United States (P<0.001), with a slight widening of this difference in recent years. (B) Comparison of eGFR at initiation of dialysis in Canada versus the United States. It shows fluctuations in both countries over time, with eGFR at dialysis progressively increasing from 2005 to 2010 and then decreasing thereafter. eGFR at initiation of dialysis has been slightly higher in Canada than in the United States (P<0.001).
- Figure 2.
Survival after initiation of dialysis (all modalities) differ for Canada and the United States. Sources: the USRDS (70) and the CORR (23). The figure compares unadjusted survival at various time points (3 months and 1, 3, and 5 years) after initiation of dialysis among patients treated in Canada versus the United States. The figure shows that mortality at 1, 3, and 5 years is consistently lower in Canada than in the United States (for 1 and 3 years; all P<0.001) but that these between-country differences have tended to narrow over time. For survival at 3 months, mortality was lower in the United States than in Canada during 2014–2016 (P<0.001), although the magnitude of the difference was very small.
- Figure 3.
Timeline of the regulatory landscape changes for ESKD in the United States, 2008–2016. The figure shows key changes in the regulatory landscape for ESKD in the United States since 2008. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 established the current expanded prospective payment system (PPS) for reimbursement for the care of patients with ESKD in the United States. There have been no substantive changes in the regulatory landscape for ESKD in Canada over this period. CMS, Centers for Medicare and Medicaid Services; ESCO, ESRD Seamless Care Organizations; HHS, US Department of Health and Human Services; MAT, Measure Assessment Tool; QIP, Quality Incentive Program. Image credit: Matt Rivara, M.D.
Tables
- Table 1.
Characteristics of patients on kidney replacement for Canada versus the United States
Patients Treated with Any Form of Kidney Replacement United States Canada Modality of kidney replacement among incident patients In-center hemodialysis 89.7 (89.5 to 89.9) 74.3 (73.1 to 75.4) Home hemodialysis 0.3 (0.3 to 0.3) 0.7 (0.4 to 0.9) Peritoneal dialysis 10.0 (9.8 to 10.2) 22.5 (21.4 to 23.6) Preemptive transplantation 1.6 (1.6 to 1.7) 0.9 (0.8 to 1.1) Modality of kidney replacement among prevalent patients In-center hemodialysis 62.0 (61.9 to 62.1) 44.1 (43.6 to 44.6) Home hemodialysis 1.2 (1.2 to 1.3) 2.9 (2.7 to 3.0) Peritoneal dialysis 7.1 (7.0 to 7.1) 11.6 (11.3 to 11.9) Transplantation 29.7 (29.6 to 29.8) 41.5 (41.0 to 42.0) Data are reported as percentage (95% confidence interval). Data from the United States were extracted from the United States Renal Data System annual data report (70). The US cohort includes Medicare and non-Medicare patients living in the 50 states, the District of Columbia, Puerto Rico, and the US territories. Data from Canada were extracted from the Canadian Organ Replacement Register annual statistics (23). The Canadian cohort includes all provinces and territories except Quebec, which was excluded because of significant under-reporting between 2011 and 2014.
- Table 2.
Characteristics of patients on incident dialysis for Canada versus the United States
Incident Patients Treated with Dialysis United States Canada Age, yr, % (95% confidence interval) <45 11.5 (11.3 to 11.7) 11.2 (10.4 to 12.0) 45–64 37.8 (37.5 to 38.1) 34.4 (33.1 to 35.7) 65–74 27.3 (27.0 to 27.6) 27.4 (26.2 to 28.6) 75+ 23.4 (23.2 to 23.6) 27.0 (25.8 to 28.2) Women, % 42.1 (41.8 to 42.4) 37.8 (36.5 to 39.1) Race, % White 67.1 (66.8 to 67.4) 63.4 (62.1 to 64.7) Black 26.1 (25.9 to 26.3) 3.3 (2.8 to 3.8) Asian 4.2 (4.1 to 4.3) 17.4 (16.4 to 18.4) Other 2.5 (2.4 to 2.6) 11.8 (10.9 to 12.7) Unknown 0.1 (0.1 to 0.1) 4.0 (3.5 to 4.5) Rural residence location, % — 18.7 (17.6 to 19.8) Baseline comorbidities, % Diabetes 56.9 (56.7 to 57.1) 56.0 (54.7 to 57.3) Heart diseasea 34.7 (34.5 to 34.9) 28.8 (27.6 to 30.0) Cerebral vascular 8.4 (8.3 to 8.5) 12.7 (11.8 to 13.6) Lung disease 9.3 (9.2 to 9.4) 12.3 (11.4 to 13.2) Hypertension 87.0 (86.9 to 87.1) 77.9 (76.8 to 79.0) Peripheral vascular disease 11.2 (11.1 to 11.3) 14.8 (13.9 to 15.7) Data are reported as percentage (95% confidence interval). Data from the United States were extracted from the United States Renal Data System annual data report (70). The US cohort includes Medicare and non-Medicare patients living in the 50 states, the District of Columbia, Puerto Rico, and the US territories. Data from Canada were extracted from the Canadian Organ Replacement Register annual statistics (23). The Canadian cohort includes all provinces and territories except Quebec, which was excluded because of significant under-reporting between 2011 and 2014.
↵a The United States includes atherosclerotic heart disease and other cardiac disease; Canada includes myocardial infarction, angina, and coronary artery bypass graft.
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