TRONDHEIN, Norway--The higher rate of end-stage renal disease in the United States when compared to European countries reflects a more severe risk of late-stage kidney disease and not a larger number of Americans in the early stages of chronic kidney disease, according to a study in the August issue of the Journal of the American Society of Nephrology.
"Our results show that the lower incidence of ESRD in Norway reflects a lower rate of progression from the early stages of CKD to dialysis, rather than a smaller pool of individuals at risk," said Dr. Stein Hallan, who led the study. "Although we did not evaluate pre-dialysis care directly, we think that strong programs to prevent diabetes and obesity and manage chronic kidney disease are needed to preserve the favorable situation in Norway and turn the tide on teh current dialysis epidemic in the United States."
Hallan and researchers from St. Olav University Hospital in Trondheim, Norway, used data from 65,000 Norwegians and 20,000 Americans to understand why ESRD rates were higher in the United States.
Researchers found no difference between the two countries in the overall prevalence of CKD. Rates were 11 percent in the United States and 10.4 percent in Norway. However, once CKD was present, the risk of progression to ESRD was 2.5 times higher for Americans than Norwegians.
American and Norwegian ESRD patients were similar in most characteristics; including age and level of remaining kidney function when starting dialysis, according to the study. However, the U.S. patients had higher rates of obesity and diabetes, which are two major and closely related kidney disease risk factors.
In addition, American patients made their first visit to a nephrologist significantly later than Norwegians during the early stages of CKD. "Early referral to a nephrologist is important," Hallan sad. "It often results in better control of diabetes and high blood pressure, as well as early and more adequate correction of anemia and disturbances in electrolyte balance. This reduces the rate of kidney disease progression, and in many patients postpones the start of dialysis."