Lecture Code : KORDS01-S1
Session Name : KORDS Report / Dialysis Center Accreditation
Session Topic : KORDS Report / Dialysis Center Accreditation
Date & Time, Place : June 12 (Fri) / 16:00-17:40 / Room 4 (203), 2F
우리나라 투석 환자 발병률 및 유병률 변화
Hajeong Lee
Seoul National University Hospital, Republic of Korea
End-stage kidney disease (ESKD) imposes a growing clinical and economic burden in Korea. For four decades, national ESKD epidemiology has rested almost entirely on the Korean Renal Data System (KORDS), the voluntary registry of the Korean Society of Nephrology. KORDS provides invaluable clinical depth, but as a voluntary registry it has structural limitations: enrollment is incomplete and its true coverage cannot be verified, non-standardized registration timing may double-count transferred patients, clinical history is often inaccurate, and patient outcomes are not systematically ascertained. To address these gaps, we used the nationwide claims database of the Health Insurance Review and Assessment Service (HIRA) and the National Health Insurance Service (NHIS) for 2011 through 2024 to characterize the contemporary epidemiology of ESKD with whole-population coverage. Incident and prevalent ESKD patients were identified by combining special-copayment registration codes with dialysis and transplant procedure and prescription codes, and chronic kidney failure was distinguished from acute kidney injury by requiring dialysis to persist beyond 90 days. Operational definitions were established through deliberation within the Society’s Registry Committee. Crude and directly age-standardized rates were calculated per million population, long-term survival was estimated by the Kaplan–Meier method, and post-ESKD cancer and cardiovascular disease were analyzed by treatment modality, age, sex and era. Crude ESKD incidence rose by approximately 46% over the study decade, yet the age-standardized incidence rate remained essentially flat, indicating that the rising number of new patients is driven by population aging rather than by a true increase in the population’s underlying risk of kidney failure. In contrast, prevalence continued to climb even after age-standardization, reflecting a maturing population that survives longer on renal replacement therapy. The treatment landscape shifted substantially: the peritoneal dialysis share of incident dialysis roughly halved (approximately 18% to 8%), while the prevalent kidney-transplant population grew several-fold. The incident patient became progressively older and more comorbid, with rising proportions of diabetes (approximately 68%), hypertension, pre-existing cardiovascular disease and prior malignancy at dialysis initiation. About half of incident hemodialysis patients still began treatment with a central venous catheter, a marker of unplanned initiation. Long-term survival followed a consistent gradient by modality (transplantation greater than peritoneal dialysis greater than hemodialysis) and a steep gradient by age, with higher mortality in men across all modalities, and showed little improvement across successive eras of dialysis onset. In conclusion, a whole-population analysis of HIRA/NHIS data shows that Korea’s rising ESKD incidence is fundamentally a demographic phenomenon, while prevalence continues to grow and the patient population becomes older, more comorbid and differently treated. The claims-based approach overcomes the coverage, duplication and follow-up limitations of voluntary registration, whereas KORDS supplies the clinical detail claims data cannot capture; the two sources are complementary rather than competing. A dual-source national surveillance model, anchored by the clinically rich KORDS registry, would give Korea its most complete and reliable picture of ESKD.
Keywords: End-stage kidney disease, Claims data, Incidence, Prevalence, Epidemiology