Comparative Epidemiology of Kidney Replacement Therapy in the United States and Israel

Israel and the United States are both high-income nations committed to providing universal access to kidney replacement therapy (KRT) for patients with end-stage kidney disease (ESKD). Despite this shared principle, the clinical and economic burden of ESKD is substantial, and each country has developed distinct strategies to deliver and finance care. This manuscript presents a comparative analysis of epidemiology, treatment modalities, and health system approaches to ESKD management in Israel and the United States, reviewing trends in dialysis prevalence, modality utilization, and kidney transplantation between 2012 and 2022, alongside differences in health policy, reimbursement structures, and cost-containment strategies. The United States, which maintains the largest ESKD population worldwide, is characterized by high dialysis prevalence and extensive federal funding through Medicare. Israel, while smaller in scale, demonstrates unique patterns of care shaped by universal health coverage and cost-regulation mechanisms. Marked differences are evident in dialysis prevalence, transplantation rates, and per-patient expenditures. Comparative evaluation of these two health systems illustrates how countries with similar commitments to universal access have developed divergent models for financing and delivering KRT, offering important insights into the impact of health system design on patient care, cost management, cultural differences, and the opportunity to learn from each other.