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2004 National Healthcare Quality Report

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Effectiveness: End Stage Renal Disease

Importance and Measures

End stage renal disease (ESRD) is the complete or nearly complete shutdown of kidney functions requiring lifetime renal replacement therapy (either dialysis or kidney transplantation).

Prevalence and Incidence

  • Over 400,000 people have ESRD in the United States.
  • Almost 100,000 new ESRD patients begin renal replacement therapy each year, and the disease is on the rise.
  • It is estimated that by 2030, there will be approximately 2.2 million ESRD patients in the Nation1.
  • Diabetes is the most common cause of ESRD, and it is expected to surpass all other causes combined in terms of ESRD incidence by 2006 and of ESRD prevalence by 20182.

Morbidity and Mortality

  • Without treatment, ESRD is fatal. Even with dialysis treatment, 20% of ESRD patients die yearly.
  • Most ESRD patients are on hemodialysis at a dialysis center 3 days a week, which seriously affects their quality of life.


  • Expenditures for ESRD totaled almost $23 billion in 2001 (Medicare and non-Medicare).
  • According to the Medicare program, ESRD expenditures totaled over $15 billion, 6.4% of the total Medicare budget in 20011.


The NHQR includes six measures to assess the quality of care provided to renal dialysis patients. Two measures are highlighted in this section:

  • Adequacy of hemodialysis, as measured by patient's urea reduction ratio (URR)
  • Percent of hemodialysis patients using arteriovenous fistulas (AVFs) for vascular access


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