Burden of disease: Prevalence and incidence of endstage renal disease in Middle Eastern countries

Background: End-stage renal disease (ESRD) is one of the leading non-communicable diseases worldwide which at the same time costs immense amount of both financial and human resources. The number of ESRD patients continues to grow, and the need to provide different modalities of renal replacement therapy (RRT) increases. Materials and methods: We conducted a retrospective study on the incidence and prevalence of RRT in the Middle East (ME) and the treatment modality, and correlated the findings with the economic status. Results: The predominant age group of patients receiving RRT in ME countries is 0 - 39, compared with the age group of 25 - 59 in Western countries. The reported prevalence of RRT is directly proportional to the economic status of the country, with low-income countries having low prevalence of RRT and high-income countries having higher prevalence. Diabetes mellitus (DM) as the leading cause of ESRD has a high prevalence in the ME according to the World Health Organization (WHO); the projected prevalence by the year 2035 is 85%. RRT in ME shows 75.81% of patients are on hemodialysis (HD), 3.25% on peritoneal dialysis (PD), and 20.93% were post-transplant recipients. Internationally, 77%, 16%, and 6% were on HD, PD, and post-transplant, respectively, in Europe; 63.1%, 6.9%, and 29.6% in the USA; and 12%, 70%, and 18% in Mexico. HD was the predominant modality of RRT in ME, while PD is underutilized, and transplantation was mostly from living donors; deceased-donor transplantation is not available in many countries. The Ministry of Health (MOH) is the main provider of RRT in ME; next, charitable organizations provide a significant proportion of RRT; and lastly, through private sectors for patients who could afford the cost of the therapy. In our survey, kidney transplantation in ME was mainly from living donors with almost 77.7% of the total kidneys transplanted while deceased donors comprised 22.3%. The overall graft survival was 93.7% and 84.23% after 1 and 5 years, respectively. Internationally, there are 17 accessible renal registries, compared with only 1 in the ME, resident in Saudi Arabia. Of the patients receiving RRT, 80% are on HD; chronic kidney disease (CKD) is found in similar to 10% of the population in the region. Conclusion: There is a high CKD burden in the ME countries. There needs to be emphasis on prevention of ESRD and provision of adequate care for the total ESRD patient population. National renal registries are needed to monitor the status of ESRD patients. Health expenditures should be increased to cover all aspects of RRT in ME Countries.