End-stage renal disease (ESRD) constitutes a growing global health and economic burden. The United States Renal Data System (USRDS) Annual Data Report 2022 documented incident treated ESRD rates of approximately 380 per million population in the United States, while the ERA Registry (European Renal Association, Annual Report 2021) reported rates of 120 to 200 per million population across European countries, illustrating substantial regional variation in incidence and treatment access.
ISN (International Society of Nephrology) has contributed to global ESRD surveillance through the Global Kidney Health Atlas and collaborative registry partnerships. The 2019 GKHA report, published in Kidney International Supplements, documented that in more than 75 countries, the vast majority of patients reaching ESRD receive no renal replacement therapy due to cost and infrastructure limitations. In low-income countries, the annual per-patient cost of hemodialysis frequently exceeds national per capita income.
Diabetic nephropathy and hypertensive kidney disease constitute the leading etiologies of ESRD globally. A systematic analysis in The Lancet Diabetes & Endocrinology (Saran et al., 2019) projected that global ESRD prevalence could reach 5.4 million by 2030 under a base case scenario, driven primarily by the growing burden of type 2 diabetes in Asia, Latin America, and sub-Saharan Africa.
Racial and ethnic disparities in ESRD incidence have been extensively documented in the USRDS Annual Reports, where Black and Hispanic populations experience ESRD at two to four times the rates observed in non-Hispanic white populations. Research by Duru et al. and analyses in the Clinical Journal of the American Society of Nephrology have linked these disparities to a combination of APOL1 genetic risk, structural social determinants, and differential access to preventive nephrology care.
The International Society of Nephrology has advocated for the development of national kidney care plans and the integration of CKD prevention into non-communicable disease programs. The ISN World Kidney Day initiative, co-sponsored with the International Federation of Kidney Foundations, has produced annual scientific themes and public education campaigns designed to increase global awareness of preventable ESRD and to support universal health coverage for kidney care.