Preventing renal disease: The ethnic challenge in the United Kingdom

Abstract

Preventing renal disease: The ethnic challenge in the United derived from ethnic communities. For instance, in Brent Kingdom. in London, 54% of the population is from a non-white background, of which the largest group is Gujarati Indian (23%). The Hammersmith Renal Unit serves, among It has been recognized for some years that migrants others, the population of Southall that is 66% ethnic, of to the United Kingdom (UK) from the Caribbean and whom 58% are Punjabi Indian in origin. It is worth the Indian subcontinent have a greatly increased risk emphasizing that the ethnic communities have a much of end-stage renal failure (ESRF) compared with white younger age structure than the Caucasian community, Caucasians (1). This is now impacting on renal services in and since renal failure from all-causes rises with age, the urban areas with large ethnic communities. Importantly, incidence seen currently is set to rise still further (3). ethnic patients also are less likely to receive a renal transplant. Hence, there is a rising number of patients IMPACT ON DIALYSIS PROGRAMS from ethnic communities in many UK renal units. It has recently been recognized that identifying the factors that Several studies have now demonstrated that the inci- contribute both to renal disease, and the way it is man- dence of ESRF among individuals from ethnic communi- aged, will be key to reducing ESRF in these communities. ties is three to five times greater than among Caucasians. Some of the most recent data comes from a London renal unit where the take on rates for individuals from DEMOGRAPHICS one borough were determined. That study showed the In the UK, the key groups of individuals who are take on rate/10 6 adult population/year was 58 for white- affected are African Caribbeans and those from the In- Caucasians, 221 for South Asians and 163 for African dian Subcontinent (including those from South Asian - Caribbeans during the period of 1994 to 1997 (4). This India, Pakistan and Bangladesh) often via migration was a minimum estimate as patients from this particular from East Africa. The African Caribbean community in borough were also dialyzed at other units. Importantly, the UK largely derived from waves of immigration in since all dialysis programs in the UK have grown in size, the 1950s and 1960s, while the South Asia immigrants this disproportion reflects not only in increased propor- started to arrive in the late 70s. More recently there has tion of ethnic patients on dialysis, but also a huge increase been a growing population of African migrants, espe- in the absolute numbers. cially from areas such as Somalia and Sudan. In the 1991 If the US is used as a benchmark for unrestricted England census, the first to formally record ethnicity, access to dialysis, then despite the excess take on rates, 3% of the adult population was Asian and 1.9% African it is likely there is a great deal of unmet need in the Caribbean. When the ethnicity of all dialysis patients in ethnic communities in the UK. The total take on rate in England was examined for the same year, 7.7% were the US is 350/10 6 adult population/year and nearly Asian and 4.7% African Caribbean (2). Local demo- 1000/10 6 adult population/year when African Americans graphics are much more striking with some boroughs alone are studied. Despite markedly lower take on rates in London having more than 50% of their population than these, most renal units in the UK are now working to capacity. If the system is to avoid meltdown, two objectives need to be met: an increase in the rate of trans-