International comparisons of survival on dialysis: are they reliable?

Sharp discrepancies between reported survivals on maintenance hemodialysis in the United States compared with Europe and Japan have provoked broad criticism of the American system of treating irreversible uremia. Although this negative view of renal therapy in the United States is supported by the National Kidney Foundation (NKF), consensus conferences of the National Institutes of Health (NIH), and numerous social critics of the American health care system, the contention has not been sustained by appropriate statistical analysis. The United States has the world's highest treatment rate for incident kidney failure - double that in Europe. This is mainly due to universal acceptance for uremia therapy. In comparisons with Japan, studies have not taken into account unique aspects of Japanese health care and genetic differences between sampled cohorts of studied kidney patients. In fact, no properly conducted analysis has found that the quality of uremia therapy in the U.S. has been inferior to that of anywhere else. While the allegation may yet be proven true, thus far there is no scientific basis for indicting dialysis in the United States as lacking in quality or quantity when ranked with other industrialized nations.