Associate Registry Research Articles

Parathyroidectomy in Patients on Renal Replacement Therapy

Secondary hyperparathyroidism is a frequent complication of long-term dialysis treatment, and despite recent advances in medical therapy, surgical parathyroidectomy (PTx) is necessary in a considerable number of uremic patients. A prevalence of PTx of 22% was reported in Europe in 1988 in patients on dialysis from 10 to 15 yr, but no large-scale epidemiologic study has been published since then. The aim of the study was to evaluate the prevalence, incidence, and risk factors for PTx in patients on renal replacement therapy (RRT) in Lombardy and to determine whether the incidence has changed over time. The study involved 14,180 patients included in the Lombardy Registry of Dialysis and Transplantation who received RRT for end-stage renal disease (ESRD) between 1983 and 1996. Cox-proportional hazards regression models were used to evaluate the risk factors of PTx, the explanatory covariates being age on admission to RRT, gender, underlying renal disease (nondiabetic or diabetic nephropathy), and dialysis modality (peritoneal dialysis or hemodialysis). The prevalence of PTx in the 7371 ERSD patients who were alive on December 31, 1996, was 5.5% and increased with the duration of RRT (9.2% after 10 to 15 yr, 20.8% after 16 to 20 yr). Similarly, the incidence of PTx increased from 3.3 per 1000 patient-years in patients who had been on RRT for <5 yr to 30 per 1000 patient-years in those receiving RRT for >10 yr. The Cox regression models showed that the relative risk for PTx was significantly higher in women and lower in elderly and diabetic patients. The relative risk for PTx (adjusted for gender, age, and nephropathy) was higher in the patients on peritoneal dialysis than in those on hemodialysis and decreased after transplantation. During the course of a follow-up of 7 yr, the incidence of PTx in patients who started RRT between 1990 and 1992 was no different from that observed in patients who started RRT between 1983 and 1985. In conclusion, the prevalence and incidence of PTx in patients receiving RRT in Lombardy is lower than that in Europe and Italy as a whole, as reported by the 1988 European Dialysis and Transplantation Association Registry; its frequency has not changed significantly during the past few years. The need for PTx decreases markedly after successful transplantation. The epidemiologic finding that the rate of PTx is greater in women, young patients, and individuals who do not have diabetes suggests the need for a more aggressive medical treatment of secondary hyperparathyroidism particularly in such patients.

Diagnosing and treating chronic prostatitis: do urologists use the four-glass test?

Objectives. To examine the diagnosis and treatment of chronic prostatitis, we conducted a national mail survey of practicing urologists in 1998. Methods. Probability samples were drawn from the American Medical Association Registry of Physicians. Results. Five hundred four urologists responded (response rate 64%). Urologists reported seeing a median of 30 patients (interquartile range 11 to 60) newly diagnosed with chronic prostatitis in the previous 12 months. Eighty percent of urologists responded that they “rarely” (47%) or “never” (33%) performed the Meares-Stamey four-glass diagnostic test. Only 4% answered “almost always.” Forty percent of urologists responded that they treat “all” their patients with antibiotics and 42% more responded that they treat “more than half” with antibiotics. Physicians who routinely performed the four-glass test did not differ in antibiotic use from those who used the test less often; however, they were more likely to use treatment other than antibiotics. For example, alpha-blockers were used in one half or more of the patients by only 35% of physicians who never do the four-glass test compared with 42% who rarely do the test and 57% who do the test more often ( P = 0.002). Results were similar for treatment with natural remedies. Conclusions. Urologists frequently diagnose chronic prostatitis but rarely perform the four-glass diagnostic test. Use of the four-glass test does not appear to affect urologists’ antibiotic treatment patterns. Although bacterial prostatitis is thought to be rare, antibiotic use in the population of men with prostatitis is not. The four-glass test and empiric antibiotics are practices in the diagnosis and treatment of prostatitis that deserve scrutiny.

Epidemiological data of treated end-stage renal failure in the European Union (EU) during the year 1995: report of the European Renal Association Registry and the National Registries.

The new Centre Questionnaire, mainly based on the collection of epidemiological data, was launched in 1996 and the overall response rate of centres for the 15 countries constituting the European Union (EU) reached 82.2% (66-100%) for 1995. We could derive the following information for a general population of 372.6 million. In 1995, the incidence of new end-stage renal failure (ESRF) patients (Ni/P) was 120 p.m.p. (per million population) with a clear north to south/west gradient (69 in Ireland, 131 in Italy and 163 in Germany). The incidence of ESRF deaths (No/P) was 67 p.m.p. (from 35 in Ireland to 89 in Germany). The net increase of patients was therefore 53 p.m.p. (from 13 in Greece to 74 in Germany). The point prevalence of treated ESRF patients (Ns/P) alive on 31 December 1995 was 644 p.m.p. (from 444 in Finland to 773 in Italy). The mean increase in the stock of ESRF patients was +8.2% (4.6 to 13.0) as a linear rate and +0.085 as a fractional rate (exponential). The first treatment of new patients (Ni) was haemodialysis (HD; 81%), peritoneal dialysis (PD; 18%) and pre-emptive renal transplantation (Tx; 1%). The latest treatment for patients still alive was HD (58.5%), PD (9%) or functional Tx (32.5%). The number of Tx was 30 p.m.p. (from 14 in Greece to 45 in Spain). The death rate was 10.4% for all those with ESRF, with 14.4% for those dialysed and 2.2% for transplanted patients. In 1995, 6.5% of dialysed patients received a graft and 4.0% of transplant patients returned to dialysis. The linear expansion rate of the dialysis pool and the transplant pool was respectively 8.3% and 7.9%. This data shows considerable disparities among countries of the EU which merit further evaluation. Also this analysis by the ERA Registry provides data of value for health and economic purposes.

Reproductive parameters of miniature stallions

Breeding soundness evaluation (BSE) of stallions is a routine component of stud farm practice. Guidelines for assessing satisfactory breeding potential have been developed using data derived from stallions of full-size breeds. In view of the increasing popularity of miniature stallions, knowledge of normal semen parameters of these stallions is important. Therefore, testicular measurements and semen parameters from 216 sexually rested miniature stallions were obtained. Semen was collected twice, 1.5 to 3 h apart, using an artificial vagina. Values were averaged over the 2 collections because of the sexual inexperience of the stallions. The smaller stallions (Group A, 72 to 86 cm; Group B, 87 to 96 cm) had smaller testicles (P<0.05), and Group A stallions had the lowest ejaculate volume (P<0.05) compared with Group C (97 to 104 cm) stallions. Thus, although there was no difference in the concentration of spermatozoa per milliliter between groups of stallions, Group A stallions had fewer total spermatozoa in their ejaculate than Group C stallions (4.31 ± 0.47 × 10 9 vs. 5.41 ± 0.30 × 10 9, P<0.05). Moreover, miniature stallions had smaller testicles and fewer total spermatozoa in their ejaculate than is commonly accepted as normal in full-size stallions. Average total scrotal width of miniature stallions was found to be 7.13, 7.38 and 7.95 cm for Groups A, B and C, respectively. The average total number of spermatozoa in the ejaculates of miniature stallions in this study was 4.94 ±0.22 × 10 9 cells, with 1.75 ± 0.09 × 10 9 total normal, motile spermatozoa. When only stallions <96.5 cm in height were considered (conforming to requirements of the American Miniature Horse Association Registry), the average total number of spermatozoa in the ejaculates was 4.59 ± 0.30 × 10 9 cells, with 1.70 ± 0.11 × 10 9 total normal, motile spermatozoa. Based on these findings, different criteria should be used to evaluate the potential breeding soundness of miniature stallions than are commonly applied to full-size stallions.

Epidemiology and demography of treated end-stage renal failure in the elderly: from the European Renal Association (ERA-EDTA) Registry.

The incidence and prevalence of end-stage renal failure in London, with permanent staV. This oYce is run by a ( ESRF ) continue to increase despite the many Managing Director and should issue and collect all Centre advancements achieved in general nephrology. This and Patient Questionnaires, in order to establish the situation is due mainly to ageing of the general popula- European data. There is a Scientific Advisory Board (SAB) composed of expert colleagues from various fields (nephrolo

Development of a burn rehabilitation unit: impact on burn center length of stay and functional outcome.

In 1995 we initiated the development of a specialized burn rehabilitation unit within an acute rehabilitation hospital, geographically separated from our burn center. The purpose was to allow an earlier initiation of an intensive rehabilitation program while still maintaining optimal burn wound care and nutritional support. The unit was directed by a burn center nurse coordinator who spent 50% of the time in the burn center and 50% in the rehabilitation unit training and supervising care. By 1996 the unit was able to manage open wounds, including skin substitutes of as much as 18% total body surface area, with 2- to 3-day returns to the center for wound coverage (2.5 +/- 0.5 procedures/patient). Our length of stay in 1996 for burns requiring inpatient rehabilitation (mean size 54% +/- 7% total body surface area) decreased by 21 +/- 5 days with respect to those in 1994 and 1995, with no increased morbidity. This length of stay was also significantly shorter (24%) than that predicted by the American Burn Association Registry formula. In addition, the rehabilitation unit length of stay required to restore the same degree of function according to a standardized measurement was significantly shorter (by 9 +/- 3 days) than for patients referred to other rehabilitation facilities in 1996. We conclude that the benefits of a burn rehabilitation unit include not only a decreased burn center length of stay but also a more rapid restoration of function.

Obstetric Anesthesia Work Force Survey, 1981 Versus 1992

BACKGROUND In 1981, with support from the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, anesthesia and obstetric providers were surveyed to identify the personnel and methods used to provide obstetric anesthesia in the United States. The survey was expanded and repeated in 1992 with support from the same organizations. METHODS Comments and questions from the American Society of Anesthesiologists Committee on Obstetrical Anesthesia and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice were added to the original survey instrument to include newer issues while allowing comparison with data from 1981. Using the American Hospital Association registry of hospitals, hospitals were differentiated by number of births per year (stratum I, > or = 1,500 births; stratum II, 500-1,499 births; stratum III, < 500 births) and by U.S. census region. A stratified random sample of hospitals was selected. Two copies of the survey were sent to the administrator of each hospital, one for the chief of obstetrics and one for the chief of anesthesiology. RESULTS Compared with 1981 data, there was an overall reduction in the number of hospitals providing obstetric care (from 4,163 to 3,545), with the decrease occurring in the smallest units (56% of stratum III hospitals in 1981 compared with 45% in 1992). More women received some type of labor analgesia and there was a 100% increase in the use of epidural analgesia. However, regional analgesia was unavailable in 20% of the smallest hospitals. Spinal analgesia for labor was used in 4% of parturients. In 1981, obstetricians provided 30% of epidural analgesia for labor; they provided only 2% in 1992. Regional anesthesia was used for 78-85% (depending on strata) of patients undergoing cesarean section, resulting in a marked decrease in the use of general anesthesia. Anesthesia for cesarean section was provided by nurse anesthetists without the medical direction of an anesthesiologist in only 4% of stratum I hospitals but in 59% of stratum III hospitals. Anesthesia personnel provided neonatal resuscitation in 10% of cesarean deliveries compared with 23% in 1981. CONCLUSIONS Compared with 1981, analgesia is more often used by parturients during labor, and general anesthesia is used less often in patients having cesarean section deliveries. In the smallest hospitals, regional analgesia for labor is still unavailable to many parturients, and more than one half of anesthetics for cesarean section are provided by nurse anesthetists without medical direction by an anesthesiologist. Obstetricians are less likely to personally provide epidural analgesia for their patients. Anesthesia personnel are less involved in newborn resuscitation.

Obstetric anesthesia work force survey, 1981 versus 1992.

In 1981, with support from the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, anesthesia and obstetric providers were surveyed to identify the personnel and methods used to provide obstetric anesthesia in the United States. The survey was expanded and repeated in 1992 with support from the same organizations. Comments and questions from the American Society of Anesthesiologists Committee on Obstetrical Anesthesia and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice were added to the original survey instrument to include newer issues while allowing comparison with data from 1981. Using the American Hospital Association registry of hospitals, hospitals were differentiated by number of births per year (stratum I, > or = 1,500 births; stratum II, 500-1,499 births; stratum III, < 500 births) and by U.S. census region. A stratified random sample of hospitals was selected. Two copies of the survey were sent to the administrator of each hospital, one for the chief of obstetrics and one for the chief of anesthesiology. Compared with 1981 data, there was an overall reduction in the number of hospitals providing obstetric care (from 4,163 to 3,545), with the decrease occurring in the smallest units (56% of stratum III hospitals in 1981 compared with 45% in 1992). More women received some type of labor analgesia and there was a 100% increase in the use of epidural analgesia. However, regional analgesia was unavailable in 20% of the smallest hospitals. Spinal analgesia for labor was used in 4% of parturients. In 1981, obstetricians provided 30% of epidural analgesia for labor; they provided only 2% in 1992. Regional anesthesia was used for 78-85% (depending on strata) of patients undergoing cesarean section, resulting in a marked decrease in the use of general anesthesia. Anesthesia for cesarean section was provided by nurse anesthetists without the medical direction of an anesthesiologist in only 4% of stratum I hospitals but in 59% of stratum III hospitals. Anesthesia personnel provided neonatal resuscitation in 10% of cesarean deliveries compared with 23% in 1981. Compared with 1981, analgesia is more often used by parturients during labor, and general anesthesia is used less often in patients having cesarean section deliveries. In the smallest hospitals, regional analgesia for labor is still unavailable to many parturients, and more than one half of anesthetics for cesarean section are provided by nurse anesthetists without medical direction by an anesthesiologist. Obstetricians are less likely to personally provide epidural analgesia for their patients. Anesthesia personnel are less involved in newborn resuscitation.

Diagnosis and Treatment of Benign Prostatic Hyperplasia: Practice Patterns of Primary Care Physicians

OBJECTIVE: To define primary care physicians' (PCPs) practices in managing patients with benign prostatic hyperplasia (BPH), and to compare these practices to portions of the Agency for Health Care Policy and Research BPH guideline and urologists' practices. DESIGN: Mail survey. PARTICIPANTS: Nationwide random sample of PCPs and urologists, selected from the American Medical Association Registry. METHODS: Initial mailing, postcard reminder, second mailing, telephone reminder, final mailing. MAIN RESULTS: Primary care physicians (n = 444, response = 51%) reported seeing a median of 35 patients with BPH over the preceding year, in contrast to 240 for urologists (n = 394, response = 68%). Regarding tests recommended by the guideline, two thirds of PCPs reported rarely or never using the American Urological Association (AUA) symptom index, nearly all reported routinely performing digital rectal examinations, and many (66%) reported routinely ordering tests to determine the serum creatinine level. Although considered "optional" by the guideline, more than 90% of PCPs reported routinely ordering a prostate-specific antigen test, while infrequently using other optional tests. Regarding "not recommended" studies, a substantial minority reported selectively or routinely ordering intravenous pyelography (34%) and renal ultrasound (33%), while two thirds reported rarely or never ordering these tests. Eighty-six percent of PCPs reported prescribing medications for BPH over the preceding year; α blockers to a median of 12 patients, and finasteride to a median of 2. Variation in urology referral thresholds was suggested in responses to two patient scenarios. CONCLUSIONS: Primary care physicians are actively managing patients with BPH. Some of their diagnostic evaluations vary from the recommendations of a national guideline and urologists' practices. Referral thresholds appear to vary considerably.

The european (european dialysis and transplantation association-european renal association) registry

The European Dialysis and Transplantation Association-European Renal Association (EDTA-ERA) Registry, now some 30 years old, has collected data throughout Europe since its inception and now covers nearly 700 million people in some 36 countries. Approximately 2,000 centers report to it. It has been possible to follow the way in which treatment for renal failure has developed in Europe, and this has not always been uniform. The nature of the treatment offered, the survival of patients on treatment, and sequentially many areas of their management have been addressed and reported. The Registry continues to work both in the field of end-stage renal failure and other fields of renal disease. It is assisting in the development of national registries and subnational renal registries throughout Europe. The multinational, multicultural nature of its area of interests makes this Registry a uniquely placed source to study many aspects of the management of patients with renal disease and of contributing to their care in the variety of healthcare system that exist in Europe and in the countries bordering the Mediterranean.

Factors influencing anaemia in dialysis patients. A special survey by the EDTA-ERA Registry

The European Dialysis and Transplantation Association-European Renal Association (EDTA-ERA) Registry conducted a special study on anaemia in dialysis patients because it seemed important to elucidate the various factors that influence the degree of anaemia and the use of regular transfusions in dialysis patients before the introduction of recombinant human erythropoietin (rHuEpo) for larger groups of patients. In a 20% sample of all patients recorded to have been dialysed throughout 1987, statistically significant associations could be found by multifactorial analysis between haemoglobin (Hb) concentration and age, sex, primary renal disease, type of treatment, hours of dialysis per week, and number of years on renal replacement therapy. The type of dialyser membrane did not seem to play a role (although there was weak evidence of an effect of the dialyser). Mean Hb concentration for dialysis patients differed between countries as did the transfusion policy. In view of the high costs of the rHuEpo treatment and potential side-effects, factors such as method of dialysis and hours of haemodialysis per week should be taken into consideration in the treatment of anaemia in dialysis patients.

Recurrence of primary renal disease on kidney graft: a European pediatric experience.

Of the 4,776 first grafts recorded in the pediatric European Dialysis and Transplant Association (EDTA) registry, 2,113 were reported to have failed and 5.6% of graft failures were related to a recurrence of primary renal disease. Nephrotic syndrome with focal and segmental glomerulosclerosis was the main renal disease prone to recur because recurrence represented 20% of the causes of graft failure in these patients; an even higher proportion was reported in a single-center experience in Europe. Other glomerulonephropathies, such as membranoproliferative glomerulonephritis and Berger's disease, were also reported to be the cause of graft failure by means of recurrence in a proportion similar to focal and segmental glomerulosclerosis. The usual recurrence of primary oxaluria was the cause of close to 50% of graft failure in this disease. Finally, hemolytic uremic syndrome recurred rarely with the graft in the EDTA registry, which is the opposite of what was reported in the United States.

The Massachusetts Adverse Drug Reacticn Project

AbstractThe Food and Drug Administration (FDA) has maintained a spontaneous voluntary system for the reporting of adverse drug events for over three decades. Based on the experience of the American Medical Association Registry for drug-related aplastic anemia, the current FDA spontaneous reporting system (FDA-SRS) was initiated in response to the public reaction to thalidomide induced phocomelia (1). A serious omission of the system has been a lack of focus on ADR observations by the health care provider. The Massachusetts Division of Food and Drugs was selected to participate in the pilot projects to promote reporting of adverse drug events. The Massachusetts Adverse Drug Reaction Project tried to increase the quantity and quality of adverse drug reaction reports filed by physicians. The basic focus of the project was to utilize various promotional mechanisms to convince providers that ADR reporting is an important public health safeguard. The project also attempted to facilitate access to reporting mech...

THE EFFECT OF THE AMERICAN HEART ASSOCIATION STEP ONE DIET ON HYPERLIPIDEMIA FOLLOWING RENAL TRANSPLANTATION

Cardiovascular disease is a frequent cause of morbidity and mortality following renal transplantation. The percentage of deaths due to ischemic cardiovascular disease and cerebrovascular accidents nearly equals that caused by infection among patients receiving their first transplant, according to data from the European Dialysis and Transplant Association Registry. Hypercholesterolemia is a risk factor for cardiovascular disease frequently identified following renal transplantation, and diets low in fat and cholesterol have been suggested as treatment. Previous studies have not reported the response of LDL cholesterol to dietary treatment, and it is this form of cholesterol that is most closely related to cardiovascular disease. The American Heart Association has provided nutritionists with guidelines for the treatment of hyperlipidemic patients which include the Step One Diet. Previous dietary studies of renal transplant recipients have allowed a slightly higher intake of fat than that currently recommended by the AHA. We wondered if an easily reproducible diet well known to nutritionists such as the AHA Step One Diet would be effective in lowering cholesterol levels in hyperlipidemic renal transplant recipients. The purpose of our study was not to define the mechanisms of posttransplant hyperlipidemia, but rather to assess the effectiveness of dietary intervention on hyperlipidemia following renal transplantation.

Renal replacement therapy in patients with diabetic nephropathy, 1980-1985. Report from the European Dialysis and Transplant Association Registry.

Diabetic nephropathy, a rarely listed cause of end-stage renal failure (ESRF) among patients starting renal replacement therapy (RRT) in the early seventies, has progressively gained in importance and become one of the major reasons for the continuous growth of the patient population on RRT in most European countries. Amongst new patients commencing RRT in 1985, the acceptance rate varied between 3 and 12 per million population for type I diabetes mellitus and between one and four per million population for type II diabetes mellitus. Nordic countries, particularly Sweden and Finland, had the highest acceptance rate of young patients with type I diabetes mellitus whose median ages were 38-42 years. In most central and southern European countries the median age of patients with type I diabetes mellitus varied between 50 and 58 years. The high number of young patients with type I diabetes mellitus and ESRF in Nordic countries point to a different natural history of this disease. It cannot be excluded, however, that the higher median age in other countries might result from doctors mistakenly diagnosing type I disease in patients with type II disease who need insulin treatment. Patients with type II diabetes mellitus had a similar age distribution at start of RRT throughout Europe and their median ages clustered around 60 years in most countries. The contribution of haemodialysis, peritoneal dialysis and renal transplantation was analysed for diabetic compared to non-diabetic ESRF. Despite large geographical differences in the proportional use of methods of treatment, a general trend to apply CAPD more frequently in diabetic as compared to non-diabetic patients was observed, and this was true for countries with both predominant haemodialysis and predominant transplant programmes. Transplantation without prior dialysis was performed in 17% of Swedish and 30% of Norwegian patients with type I diabetes mellitus. In order to better explain the mortality of patients with diabetic ESRF, the proportional distribution of causes of death was analysed. Myocardial ischaemia and infarction was confirmed to be the leading cause of death in patients with diabetes mellitus on RRT. The coronary death rate was estimated to be 10 times greater in young patients with type I diabetes mellitus as compared to their non-diabetic counterparts. Other cardiovascular as well as infectious causes were recorded in a similar proportion of deaths in diabetics as in non-diabetics. Cancer deaths, however, appeared to be definitely less frequent in patients on RRT due to diabetic nephropathy.

Demography of Dialysis and Transplantation in Children in Europe, 1985&lt;subtitle&gt;Report from the European Dialysis and Transplant Association Registry&lt;/subtitle&gt;

The demography of renal replacement therapy up until the close of 1984 in Europe is presented, based on return of individual patient questionnaires to the EDTA Registry. These were completed by 84.7% of known centres in 33 countries. Of 187,267 individually registered patients, 102,276 were known to be alive on defined forms of renal replacement therapy on 31 December 1984. The stock of patients alive on treatment by dialysis and transplantation in Europe continued to grow and exceeded 200 per million population in 14 European countries at the end of 1984. During the same year, 21,198 new patients were accepted for treatment in Europe, and crude acceptance rates for new patients exceeded 60 per million population in four countries. Acceptance rates for elderly patients continued to increase and age specific acceptance rates for males aged 65 and over exceeded 100 per million population in 12 countries. A total of 6802 renal transplants were reported during 1984. Regrafting accounted for a higher proportion of transplants in Nordic countries and in the United Kingdom, compared with other nations. During 1984 the total number of transplants reported to the Registry passed 50,000. The distribution of primary renal disease amongst adult patients commencing treatment in 1984 is presented. Amongst elderly patients commencing treatment, a strikingly high proportion have chronic renal failure of uncertain aetiology. Finally, causes of death have been analysed amongst adult patients dying during 1984, showing myocardial ischaemia and infarction to be the leading cause of mortality.

A simulation model for planning services for renal patients in Europe.

A discrete-event simulation model is being developed to provide information for national and regional health planners about the effect of different treatment policies and practices on the increasing numbers of patients with irreversible kidney failure. The simulation program, written in Pascal using Pascal-SIM, describes the activities of individual patients whose progress through treatment depends on their characteristics and treatment history, as well as on treatments availability. Programming techniques have been developed to cope with the multiple scheduling of patient entities and the resultant queue-management problems. In order to provide simulation runs on request, for any population group, appropriate data is selected from the European Dialysis and Transplant Association Registry data base for use in the simulation program. Results are shown on a computer screen while the simulation is running, and are saved for further analysis to provide feedback to the requesting organization.

Alport's syndrome as a cause of renal failure in Europe

We studied the geographical distribution, male to female ratio, and age at the start of renal replacement therapy (RRT) for end-stage renal failure (ESRF) in 600 patients with hereditary nephritis with nerve deafness (Alport's syndrome) reported to the European Dialysis and Transplant Association Registry since 1975. Annual age- and sex-specific acceptance rates for RRT showed a variable peak incidence according to country, ranging between, 0 and 2.4 patients per million population in males aged 15-24 years, but with only about half this incidence in females. In Scandinavian countries there were very few females who started RRT, and males were older than in the rest of Europe. The overall male to female ratio was 4:1. The median age at the start of RRT was: males (n = 479) 24.3 years (1st quartile 19.5 years; 3rd quartile 31.5 years); females (n = 121) 31.5 years (1st quartile 23.0 years; 3rd quartile 43.2 years). Our study provided confirmation that males reach ESRF earlier than females. In addition, we detected previously unrecognized geographical differences.

Current thinking on the management of the uremic diabetic.

BOUT HALF of all type-1 diabetics, and an undefined but lesser proportion of type-II diabetics, will develop chronic renal failure (CRF). Diabetics constitute about one-fourth of end-stage renal disease patients in the United States, and a lesser but steadily increasing proportion (7.3% in 1981) in Europe.’ In general it has been found that diabetics suffer inordinately high morbidity and mortality compared to non-diabetic CRF patients. Data from the European Dialysis and Transplant Association Registry found only 70% one-year, and 28% five-year survival of diabetic CRF patients, roughly equivalent to the survival of nondiabetics 20 to 30 years older. The costs in human terms are enormous, and are reflected in dollar expense as well: we examined the first-year costs of transplanting 30 type-1 diabetics at our center and found that hospital charges were one-third higher for diabetics compared to a group of non-diabetic recipients.2 We will discuss aspects of treating the diabetic with advanced nephropathy that we feel are of importance in optimizing survival and rehabilitation. It is our strongly held opinion that effective application of currently available modalities offers much more to the diabetic patient than past statistics might indicate.

Demography of Dialysis and Transplantation in Europe, 1984&lt;subtitle&gt;Report from the European Dialysis and Transplant Association Registry&lt;xref ref-type="fn" rid="fn1" /&gt;&lt;/subtitle&gt;

Demography of Dialysis and Transplantation in Europe, 1984&lt;subtitle&gt;Report from the European Dialysis and Transplant Association Registry&lt;xref ref-type="fn" rid="fn1" /&gt;&lt;/subtitle&gt;