letters to the editor
org
Trends in end-stage kidney
disease in Shanghai, China
To the editor: We read with interest the review by Wang
et al. on the burden of chronic kidney disease in North and
East Asia.1
Because there are no comprehensive end-stage kidney
disease (ESKD) registries available from China, we report here
data from Shanghai, the most populous city in China. The
Shanghai Center for Hemodialysis Quality Control estab-
lished an online registry system in 2007 to capture all patients
receiving chronic hemo- or peritoneal dialysis for more than
90 days.2 Underlying population size was determined by
means of the Shanghai household registration. Most
Shanghai residents have very good medical reimbursement
support through the local government to access chronic
dialysis.3 From 2007 to 2014, ESKD incidence ranged from
89.4 to 128.1 per million population years without a clear
temporal trend. In contrast, ESKD prevalence increased
steadily from 409.8 per million population years in 2007 to
898.2 per million population years in 2014 (Figure 1).
Thus, we report a prevalence of treated ESKD in Shanghai
that is much higher than that quoted in the review by Wang
et al. (544.7 per million population years in 2011).1,4 Because
only dialysis patients are captured and transplant patients are
not counted, these figures actually underestimate the burden
Figure 1 | The incidence and prevalence of reported end-stage kidney disease (ESKD) in Shanghai from 2007 to 2014.
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of treated ESKD. The relative stability of incidence of treated
ESKD suggests that expanded access to renal replacement
therapy is not the primary reason for the rapid rise in treated
ESKD prevalence in Shanghai; rather, patients are living
longer on maintenance dialysis. Our data further highlight the
large and growing burden of kidney disease in North and East
Asia.
1. Wang J, Zhang L, Tang SC-w, et al. Disease burden and challenges of
chronic kidney disease in North and East Asia. Kidney Int. 2018;94:22–25.
2. Shanghai Renal Data System. Available at: http://www.cnrds.org/. Accessed
July 30, 2018.
3. Shanghai Statistical Yearbook 2014. Available at: http://www.stats-sh.gov.
cn/html/sjfb/201701/1000199.html. Accessed July 30, 2018.
4. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for
end-stage kidney disease: a systematic review. Lancet. 2015;385:1975–1982.
Zijin Chen1,2, Weiming Zhang3, Xiaonong Chen1
and Chi-yuan Hsu2
1
Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai
Jiao Tong University, Shanghai, China; 2Division of Nephrology, Department
of Medicine, University of California, San Francisco, San Francisco, California,
USA; and 3Department of Nephrology, Renji Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
Correspondence: Xiaonong Chen, Department of Nephrology, Ruijin Hos-
pital, No 197 Ruijin Er Road, Shanghai, China, 200025. E-mail:
cxn10419@rjh.com.cn
Kidney International (2019) 95, 232; https://doi.org/10.1016/j.kint.2018.08.044
Copyright ª 2018, International Society of Nephrology. Published by
Elsevier Inc. All rights reserved.
Kidney International (2019) 95, 232–235