Trends in the incidence of end-stage renal failure due to hypertension and vascular disease in Australia, 1972-1991.

Abstract

Despite the known protective effects upon renal function of lowering blood pressure in primary chronic renal disease, diabetes and malignant hypertension, the number of patients entering dialysis and transplantation programmes with renal failure due to hypertension or vascular disease remains high. To analyse the trends in incidence of arteriopathic end-stage renal failure. Calculation of mean annual age- and sex-specific rates (by decade) and truncated age-standardised rates for entry into Australian end-stage renal failure programmes in the period 1972-1991. Statistical analysis by chi-squared test, assuming a Poisson distribution of cases. End-stage renal failure attributed primarily to hypertension or vascular disease fell to less than half its former level over the period of observation in persons aged 15-54 years. This change has occurred only in the diagnostic category 'malignant hypertension'. Trends in persons aged 55 years and over are more difficult to analyse because of changing criteria for entry into renal failure programmes, but there has been no indication of any fall in incidence. The aetiology and pathology of arteriopathic renal failure is diverse, with different patterns in young and old adults. The formerly common pathology in young adults is largely preventable by modern antihypertensive therapy, while arteriopathic renal disease in older persons is not.