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International comparisons of the characteristics of people with chronic kidney disease (CKD) are scarce, despite large amounts of data being electronically captured in clinical systems. This unmet need is likely attributable to challenges in harmonizing data from different clinical systems and the fundamental need to adhere to various data protection regulations from country-to-country. A global kidney care provider recently created a fully anonymized dialysis dataset (Apollo DB) that combines and harmonizes real-world data from 40 countries across 6 continents for quality improvement and research efforts. We assessed the country-level demographic characteristics of dialysis patients in the dataset.
Apollo DB captures longitudinal real-world data on an observation-level (each treatment, lab, value) from 40 countries in a global kidney provider network. Data from different electronic systems is harmonized and anonymized on a periodic basis. Anonymization is performed using logic established in a formal re-identification risk assessment. Data is consolidated and stored in a central cloud environment. The first version of Apollo DB captured data on more than 360 variables from Jan 2018 to Mar 2021. Variables included data on demographics, diagnoses, laboratories, medications, treatments, quality of life surveys, and outcomes.
Apollo DB includes data on 543,169 adult (age ≥18 years) dialysis patients from 40 countries. The distribution of demographics of patients showed some regional distinctions from country-to-country. The age of patients at the progression to kidney failure and initiation of dialysis was most commonly 45-64 years old, yet this was not consistent on a country-level (Figure 1). In some countries, the highest proportion of patients started dialysis at an age between 18-44 years old (e.g., Kazakhstan, Kyrgyzstan, Ukraine), while in other countries the highest proportion of patients started dialysis at an age of ≥75 years old (e.g., France, Spain, Portugal). Overall, 41.8% of patients were female (Figure 2). On a country-level, the distribution of biological sex varied from about 50% of female patients (e.g., Indonesia, Taiwan, Philippines) to about 30% of female patients (e.g., Ireland, Sweden, India).
We observed geographical distinctions in the demographics of dialysis patients in 40 countries represented in Apollo DB. The age category of patients at the progression to kidney failure was remarkably different from country-to-country, a finding that may indicate differences in the etiology of CKD. The distribution of the biological sex of patients varied by up to 20% on a country-level. These profiles act as benchmarks for the nephrology community. Further international assessments of dialysis patient characteristics are needed.