Incidence Rate Of End-stage Renal Disease Research Articles

A systematic review of ethnic differences in the rate of renal progression in CKD patients

Chronic kidney disease (CKD) is a public health problem of increasing importance, consuming a growing proportion of health care resources. It is estimated that, in the United States, there are 19.2 million individuals with CKD [1], and this figure is expected to increase in parallel to the rising prevalence of hypertension and diabetes. By 2010, the projected number of end-stage renal disease (ESRD) patients will climb to over 650 000 [2], with a further predicted increase to 2.24 million by 2030 [3]. Therefore, improved understanding of the predictors of GFR decline is essential. Information about predictors would allow nephrologists to accurately predict those CKD patients at risk of progressing to ESRD, which would help to individualize patient care, allowing for optimal planning for renal replacement therapy (RRT), reduce the need for urgent dialysis and ultimately allow for more efficient allocation of scarce health care resources. In addition, the recognition of novel risk factors for progression may lead to the development of new therapies capable of altering the trajectory of the disease. It has been recognized that the incidence of ESRD is higher in ethnic minorities; however, the reasons for this have not been well defined. For example, American blacks are four times more likely to require dialysis than whites [4]. An increased burden of ESRD has also been shown to affect Hispanics and Asians [5]. Conversely, ethnic minorities tend, paradoxically, to have improved outcomes once started on haemodialysis [5,6]. Several mechanisms have been suggested to explain such differences, though these have not been proven. For example, a higher prevalence of co-morbidities, lower socioeconomic status and comparatively worse access to health care among ethnic minorities have been cited as reasons for the higher incidence of ESRD [7–9]. Such reasoning holds that the incidence of ESRD is dependent on the number of CKD patients at risk of progressing, and the higher prevalence of diabetes and hypertension in blacks may result in greater CKD [4]. Similarly, lower socioeconomic status in minorities may create inequalities in access to health care resources and thus reduce delivery of medical management known to slow the progression of renal dysfunction [10,11]. A second explanation is that a higher death rate amongst CKD patients in one ethnic group would leave fewer patients alive to require RRT, thus affecting the observed incidence rate of ESRD. Different thresholds for starting RRTwould also affect the measured incidence of ESRD. Finally, the higher incidence of ESRD amongst ethnic minorities may in fact be due to a faster rate of GFR decline and more rapid progression of renal disease. The purpose of this review is to summarize the available evidence on ethnic differences in the rates of CKD progression towards ESRD. Ideally, available studies would directly observe rates of GFR decline in CKD cohorts of different races. This would avoid such confounders as CKD prevalence, the competing risk of death and varying thresholds for starting RRT. Alternatively, in studies examining the incidence rates of ESRD, inferences can be made regarding progression rates only if attempts are made to account for differences in the baseline prevalence of CKD and in longitudinal mortality rates.

Risk Implications of the New CKD Epidemiology Collaboration (CKD-EPI) Equation Compared With the MDRD Study Equation for Estimated GFR: The Atherosclerosis Risk in Communities (ARIC) Study

The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recently published an equation for estimated glomerular filtration rate (eGFR) using the same variables (serum creatinine level, age, sex, and race) as the Modification of Diet in Renal Disease (MDRD) Study equation. Although the CKD-EPI equation estimates GFR more precisely compared with the MDRD Study equation, whether this equation improves risk prediction is unknown. Prospective cohort study, the Atherosclerosis Risk in Communities (ARIC) Study. 13,905 middle-aged participants without a history of cardiovascular disease with median follow-up of 16.9 years. eGFR. We compared the association of eGFR in categories (>or=120, 90-119, 60-89, 30-59, and <30 mL/min/1.73 m(2)) using the CKD-EPI and MDRD Study equations with risk of incident end-stage renal disease, all-cause mortality, coronary heart disease, and stroke. The median value for eGFR(CKD-EPI) was higher than that for eGFR(MDRD) (97.6 vs 88.8 mL/min/1.73 m(2); P < 0.001). The CKD-EPI equation reclassified 44.9% (n = 3,079) and 43.5% (n = 151) of participants with eGFR(MDRD) of 60-89 and 30-59 mL/min/1.73 m(2), respectively, upward to a higher eGFR category, but reclassified no one with eGFR(MDRD) of 90-119 or <30 mL/min/1.73 m(2), decreasing the prevalence of CKD stages 3-5 from 2.7% to 1.6%. Participants with eGFR(MDRD) of 30-59 mL/min/1.73 m(2) who were reclassified upward had lower risk compared with those who were not reclassified (end-stage renal disease incidence rate ratio, 0.10 [95% CI, 0.03-0.33]; all-cause mortality, 0.30 [95% CI, 0.19-0.48]; coronary heart disease, 0.36 [95% CI, 0.21-0.61]; and stroke, 0.50 [95% CI, 0.24-1.02]). Similar results were observed for participants with eGFR(MDRD) of 60-89 mL/min/1.73 m(2). More frequent reclassification of younger, female, and white participants explained some of these trends. Net reclassification improvement in participants with eGFR < 120 mL/min/1.73 m(2) was positive for all outcomes (P < 0.001). Limited number of cases with eGFR < 60 mL/min/1.73 m(2) and no measurement of albuminuria. The CKD-EPI equation more appropriately categorized individuals with respect to long-term clinical risk compared with the MDRD Study equation, suggesting improved clinical usefulness in this middle-aged population.

Are segments of the developing world competing in end-stage renal disease (ESRD)?

Sir, Trinidad and Tobago are the southernmost islands in the Caribbean archipelago with a population of 1.3 million, consisting of two major diaspora Africans and Southeast Asians. An economy buoyant by petroleum exports is responsible for a GDP per capita of 10 894.4 ($US). The number of patients (n = 436) with ESRD receiving dialysis is the highest in comparison with Jamaica (n = 366), Bahamas (n = 211), Barbados (n = 185), Cayman Islands (n = 41) and the British Virgin Islands (n = 27) [1]. In Jamaica and Trinidad, the two most common causes of ESRD are diabetes and hypertension. The management of ESRD in Trinidad is mainly by dialysis provided by the state at two major tertiary centres on the island. To receive dialysis, patients must only be hepatitis B surface antigen negative; patients infected with the human immunodeficiency virus (HIV) or those who are hepatitis C virus (HCV) seropositive are not excluded. A study of the trends in the prevalence and epidemiology of ESRD during the period 1999–2007 at one of these haemodialysis sites was conducted using a retrospective cohort design. Between 1999 and 2004 the number of new cases seeking dialysis was 5 per annum; however, in 2005, 2006 and 2007, there were 14, 16 and 26 new cases, respectively. During this period there were no unusual patterns of disease occurrences or any special interventions, either clinical or promotional, to detect renal disease. The mean age among men was 52 (SD ± 13.9) years as compared to women 46.8 (SD ± 14.9) years; a similar finding was reported by Soyibo and Barton [1]. In contrast, Reikes showed in 2000 that, in the United States, the highest incidence rate of ESRD occurs in patients 64 years and older [2]. This implies that in the Caribbean population ESRD occurs at an earlier age. There were more Africans (45.7%) than Southeast Asians (39.5%), and hypertension (70.4%) and diabetes (40.7%) were the commonest comorbid conditions, similar to findings reported by Brown [3] and Lane et al. [4]. In conclusion, we provide epidemiological evidence of ESRD of epidemic proportions in Trinidad. Conflict of interest statement. None declared.

D&amp;T Report

D&amp;T Report

Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991–2005)

We aimed to update the epidemiology of type 1 and type 2 diabetic patients among the incident end-stage renal disease (ESRD) population in Australia and New Zealand (ANZ) and to determine whether outcome is worse for diabetic women, as described in the general population. All resident adults of ANZ who began renal replacement therapy (RRT) from 1 April 1991 to 31 December 2005 were included using data from the ANZ Dialysis and Transplant Registry. Incidence rates, RRT, and survival were analyzed. Risk factors for death were assessed using Cox regression. The study included 1,284 type 1 diabetic (4.5%), 8,560 type 2 diabetic (30.0%), and 18,704 nondiabetic (65.5%) patients. The incidence rate of ESRD with type 2 diabetes increased markedly over time (+10.2% annually, P < 0.0001). In patients aged <70 years, rates of renal transplantation in type 1 diabetic, type 2 diabetic, and nondiabetic patients were 41.8, 6.5 (P < 0.0001 vs. other patients), and 40.9% (P = 0.56 vs. type 1 diabetic patients), respectively. Compared with nondiabetic patients, the adjusted hazard ratio (HR) for death was 1.64 (P < 0.0001) in type 1 diabetes and 1.13 (P < 0.0001) in type 2 diabetes. Survival rates per 5-year period improved by 6% in type 1 diabetic patients (P = 0.36), by 9% in type 2 diabetic patients (P < 0.0001), and by 5% in nondiabetic patients (P = 0.001). In type 2 diabetic patients aged >or=60 years, the adjusted HR for death in women versus men was 1.19 (P = 0.0003). The incidence of ESRD with type 2 diabetes increased markedly. Despite high access to renal transplants, type 1 diabetic patients had a poor prognosis after starting RRT. Survival improved significantly in type 2 diabetic patients during the study period. Older type 2 diabetic women had a worse prognosis than older type 2 diabetic men.

Geographical patterns of end-stage renal disease incidence and risk factors in rural and urban areas of South Carolina

To assess the geographical patterns of end-stage renal disease (ESRD) incidence and to identify the risk factors on the regional differences, the authors conducted an ecological study on incidence of ESRD and related risk factors in the 46 counties of South Carolina (SC). Age and gender adjusted, race specific incidence rates for each county in SC were calculated for the 11,346 ESRD patients of all ages who registered in the United States Renal Data Systems Network 6 from 1990 to 1999. County level exposure measures on population physician density, hospitalization rates of diabetes and hypertension, per capita income, percent college degree, and percent below poverty were evaluated. There was a significant increase in mean incidence rates of ESRD from 1990 to 1999 in SC ( p < 0.0001 ) . The incidence rates were consistently higher in rural than in urban counties. Population physician density (relative risk (RR) 0.49, 95% confidence interval (95%Cl, 0.41–0.58) and rural residence (adjusted RR 1.66, 95%Cl 1.59–1.74) were significantly associated with ESRD incidence. The strong relationship between ESRD and physician density suggests that access to adequate treatment of diabetes and hypertension is of paramount importance for ESRD prevention, and has important public policy implications.

Prevalence of chronic kidney disease and anemia among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study: Baseline results

Prevalence of chronic kidney disease and anemia among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study: Baseline results

Is Population-Wide Diuretic Use Directly Associated With the Incidence of End-Stage Renal Disease in the United States?: A Hypothesis

We introduce the hypothesis that population-wide use of diuretics might be associated with acceleration of the incidence of end-stage renal disease (ESRD). Based on the technique of data fusion, pooled-data trends in disease incidence and antihypertensive medication use were examined to determine whether changes in drug use patterns are predictive of disease emergence in the United States. National databases for all-cause cardiovascular disease (CVD) mortality and stroke mortality from the National Vital Statistics Registry, renal failure data obtained from the United States Renal Data Service, and drug information obtained from IMS Health (Fairfield, CT) were examined. A statistically significant inverse relationship was observed between all-cause CVD mortality rates and ESRD incidence rates for the period 1980 to 1998 (r = -0.98948; P < .0001). A statistically significant direct time-lagged relationship was found between both annual changes in diuretic distribution and total diuretic expenditure to annual changes in the ESRD growth rate (r = 0.754, P = .03, r(2) = 0.568, 95% CI for slope = 0.08975 to 1.3010). Increasing annual diuretic distribution in the US is directly associated with accelerated time-lagged growth rates of ESRD incidence. One potential explanation is that diuretic therapy could promote ESRD expression. A large-scale, randomized, controlled trial to investigate acceleration of ESRD by diuretics would be justifiable. The data invites the hypothesis that reliance on nondiuretic antihypertensive therapies such as calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers might attenuate the epidemic rise of ESRD that is prevalent in the United States.

Health economics of renal replacement therapy: Perspectives from Singapore

The prevalence of end-stage renal disease (ESRD) in Singapore is high and projected to increase sharply due to the aging population and the high prevalence of diabetes. The number of patients treated with dialysis was projected to rise from 2633 in 1999 to nearly 6000 in the year 2010. The cost of dialysis provision was estimated to increase 2.5-fold from US dollar 90 million in 1999 to US dollar 241 million in 2010. To address this, the Singapore Ministry of Health launched three initiatives in the year 2000: First, to reduce the incidence of ESRD through (1) primary prevention of diabetes, (2) community-based screening to facilitate early detection of patients with diabetes, (3) improving glycemic and blood pressure (BP) control of diabetics in the primary care setting, and (4) the establishment of dedicated Renal Retardation clinics to optimize BP control (and glycemic control for diabetics), and reduce the level of proteinuria in patients at high risk of ESRD development. Second, to increase the percentage of ESRD patients treated with continuous ambulatory peritoneal dialysis (CAPD), which is a lower-cost modality compared with hemodialysis; and third, amendments to the existing opt-out legislation for organ procurement for transplantation to increase the supply of kidneys for cadaveric renal transplant.

Trends in incidence of end-stage renal disease in Japan, 1983-2000: age-adjusted and age-specific rates by gender and cause.

Trends in age-adjusted or age-specific incidence rates of end-stage renal disease (ESRD) have never been examined in Japan, a major ESRD epidemic area. A nationwide registry has provided the number of ESRD patients commencing maintenance renal replacement therapy for time period from 1983 to 2000. We computed gender- and age-specific incidence rates of ESRD over 2-year periods, in total or by cause. Age-adjusted incidence rates were calculated using the 1985 Model Population of Japan as the standard. Causes of ESRD in 1999-2000 were, in order of decreasing frequency, diabetic nephropathy, chronic glomerulonephritis, unknown causes, nephrosclerosis and polycystic kidney disease in men, and chronic glomerulonephritis, diabetic nephropathy, unknown causes, nephrosclerosis and polycystic kidney disease in women. The age-adjusted all-cause incidence of ESRD increased until 1995-1996, but has since levelled off in both genders. The age-adjusted rate for diabetic nephropathy has been rapidly increasing, while that for chronic glomerulonephritis has decreased since 1995-1996. The former rate exceeded the latter in 1997-1998 in men. All-cause ESRD has rapidly increased in the eighties age group, whereas the increase slowed down in younger age groups in the late 1990s. The rate for diabetic nephropathy has linearly risen in almost every age group in men, whereas it began to level off in women aged 40-59 years at about 1995. For chronic glomerulonephritis, the rate had already started to decline in the mid-1980s in those aged <45 years. The rate of nephrosclerosis has been increasing independently of age. The present study shows changes in the epidemiological features of the incidence of ESRD in Japan from 1983 to 2000.

Age distribution and yearly changes in the incidence of ESRD in Japan

Background: Although several treatment and screening methods have been tried, the incidence of patients with end-stage renal disease (ESRD) on renal replacement therapy (RRT) continues to increase worldwide. By making a detailed analysis of the major primary renal diseases, we found there have been some favorable effects in the incidence rate of ESRD recently in Japan. Methods: A total of 339,478 patients in Japan and 909,591 patients in the United States started RRT between 1983 and 1999. We compared trends of average age and incidence rate in each age group with major primary renal diseases and in racial groups after adjusting for general population aging by using a linear regression analysis. Results: All trends in ESRD incidence rates among Japanese, US total, US white, and US black patients showed significant increases (P < 0.001). A significant positive linear relationship between year and mean age at start of RRT also was observed (P < 0.001). After adjustment for general population aging, the mean age increment in Japanese patients with glomerulonephritis was increased significantly, and the proportion of Japanese patients who had glomerulonephritis and were younger than 45 years was decreased, but this decrement was not observed in US patients with glomerulonephritis. Conclusion: The reduced number of new patients with ESRD with glomerulonephritis might be caused by early detection and early referral to nephrologists as a result of the Japanese urinalysis-screening program. To reduce the ESRD population, it will be necessary to establish more effective treatment methods to delay exacerbation of progressive renal diseases.

Relationships of race and ethnicity to progression of kidney dysfunction and clinical outcomes in patients with chronic kidney failure

In the United States, the incidence of end-stage renal disease (ESRD) is much higher for blacks, Native Americans, and Asians than for whites. The incidence of kidney disease is also higher for populations of Hispanic ethnicity. ESRD attributed to diabetes (ESRD-DM), hypertension (ESRD-HT), and glomerulonephritis (ESRD-GN), in this order of frequency, are the major categories of ESRD in the United States for all race/ethnic groups. By using the incidence rates of ESRD, during the period from 1997 through 2000, and with whites as reference, the highest rate ratio (RR) was observed for ESRD-HT in blacks (RR = 5.96), ESRD-DM in Native Americans (RR = 5.11), and ESRD-GN in Asians (RR=2.20). The data suggest that the excess of ESRD observed for racial/ethnic minorities may be reduced by interventions aimed at prevention/control of hypertension and diabetes. The data suggest that before developing ESRD, patients with chronic renal failure from minority groups have to face more barriers to receive high-quality health care. This may explain why they see nephrologists later and are less likely to receive renal transplantation at initiation of renal replacement therapy (RRT). Improvements in quality of care after initiating RRT may explain the lower mortality and higher scores in heath-related quality of life observed for patients from racial/ethnic minorities.

Incidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: a report from the allegheny county registry

Background:Little information is available regarding the long-term incidence of end-stage renal disease (ESRD) and survival after the introduction of renal replacement therapy (RRT) in patients with type 1 diabetes. Methods:We studied 1,075 patients with type 1 diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who comprise the Allegheny County population-based registry. Onset of ESRD was defined as the introduction of RRT (dialysis or transplantation). Results:Of 1,075 registrants, the living status of 975 patients (90.7%) and complication status of 798 patients (74.2%) were ascertained as of January 1, 1999. During the observation period, 104 patients (13.0%) developed ESRD, for an incidence rate of 521/100,000 person-years (95% confidence interval, 424 to 629). The cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant decline was observed in 20-year cumulative incidence rates of ESRD for patients diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%, and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients (28%) received dialysis alone, 44 patients (42%) received dialysis followed by kidney transplantation, 26 patients (25%) underwent successful transplantation alone, and 5 patients (5%) underwent a failed kidney transplantation followed by dialysis therapy. The cumulative survival rate 10 years after the introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy followed by kidney transplantation was significantly greater than that of dialysis therapy alone (P < 0.001). No difference was detected in survival between pancreas-kidney transplant recipients and kidney-alone transplant recipients (P = 0.7). Conclusion:The incidence of ESRD observed in this cohort has declined, probably reflecting the better glycemic and blood pressure control available since the early 1980s.

The contribution of increased diabetes prevalence and improved myocardial infarction and stroke survival to the increase in treated end-stage renal disease.

This study examined the extent to which the greater than threefold increase in number of treated end-stage renal disease (ESRD) cases between 1978 and 1991 is explained by increases in the prevalence of diabetes, myocardial infarction (MI) and stroke survivors, and US population size. The change in number of persons in the United States with diabetes, a history of MI or stroke, and without these conditions was estimated for 1978 and 1991 using the Second and Third National Health and Nutrition Examination Surveys. The treated ESRD incidence rate and the increase in ESRD treatment attributable to each of these populations were calculated using these estimates and data from the United States Renal Data System. In the United States, there were an estimated 4.3 and 1.2 million more persons with diabetes and a history of MI or stroke, respectively, 22.7 million more persons without these conditions, and 36,881 more incident treated ESRD cases in 1991 compared with 1978. In 1991, treated ESRD incidence rates among persons with diabetes, a history of MI or stroke, and without these conditions were 2567, 1463, and 153 cases per million person-years, respectively. In 1991, 10,183 cases of the additional 36,881 treated ESRD cases (27.6%) resulted from the higher prevalence of diabetes; 1775 (4.8%) from increased MI and stroke survival; and 2904 (7.9%) resulted from growth of the US population without these conditions. The increasing number of treated ESRD cases in the United States is partly explained by the increase in diabetes prevalence and US population growth but only minimally by MI and stroke survival.

End-stage renal disease in the Asian-Pacific region.

Information on end-stage renal disease (ESRD) is important in assisting health care providers in planning renal replacement therapy. A questionnaire was sent to various countries in the Asian Pacific region and 10 countries responded. Data from Australia and New Zealand was obtained from their registry report. The questionnaire requested information on incidence, prevalence, transplantation rate, demographic data, causes of ESRD, causes of death, and mortality rates for the years 1998 to 2000. All the countries surveyed had national registries and there was a greater than 90% response rate in 7 of 12 countries. The incidence and prevalence rates of ESRD were linked to funding of dialysis, with higher reported rates in countries where dialysis was totally or heavily subsidized by the government. There was an increase in both incidence and prevalence rates between 1998 and 2000, with the mean annual percentage increase of 1.2% to 14.1% for incidence and 4.2% to 17.3% for prevalence. Diabetic nephropathy was the most common cause of ESRD in 9 of the 12 countries surveyed and 6 of the 12 countries had greater than 35% of their dialysis patients age 60 years and older. Peritoneal dialysis (PD) use varied between 3.9% to 81% of the dialysis population and reflected the health care policies of the individual countries. The transplantation rate was influenced by socioeconomic, religious, and cultural attitudes and varied between 3.1 per million population (pmp) to 32 pmp with the percentage of cadaveric transplants ranging between 0% of 85% of total transplants. Cardiovascular mortality remained the most common cause of death in the ESRD patients. Collaboration between the various national registries in the form of specific international studies may yield useful information of ESRD patients in the Asian-Pacific region.

Racial disparities in kidney health: The puzzle to solve

Racial disparities in kidney health: The puzzle to solve

ESRD in Australia and New Zealand at the end of the millennium: A report from the ANZDATA registry

Background: The incidence and prevalence of treated end-stage renal disease (ESRD) continues to grow throughout the world; however, there is substantial variation between countries in ESRD incidence and outcomes of renal replacement therapy (RRT). The manner of addressing this challenge varies around the world as seen in different patterns of RRT. We present here a summary of the incidence and prevalence of treated ESRD in Australia and New Zealand in 2000. Methods: Data are derived from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), which collects data about all patients receiving RRT from all renal units in Australia and New Zealand on a 6-monthly basis. Results: The crude incidence rates of new RRT patients for 2000 for Australia and New Zealand were 92 and 107 per million population, respectively. Prevalence rates (December 31, 2000) of dialysis-treated patients were 334 per million in Australia and 348 per million in New Zealand, with 273 per million functioning kidney transplants in Australia and 267 per million in New Zealand. The principal area of increase has been in the older patients (≥65 years), where age-specific rates still are increasing. Death rates remained in excess of the general population, with cardiac and infective causes predominant among dialysis patients and cardiac, infective, and malignant causes among transplant recipients. Data about hemodialysis treatments showed a continuing trend toward greater dose of hemodialysis achieved principally through increases in blood flow rate rather than increasing treatment time. Use of erythropoietic agents was common although more restricted in New Zealand by government regulation. Cadaveric transplantation rates were stable, but there has been a steady increase in the proportion of grafts from live donors. Practice in immunosuppression appears to be rapidly changing, with near-universal use of corticosteroids and mycophenolate as part of an initial therapy regimen with a calcineurin inhibitor. Tacrolimus, however, has rapidly increased in its use, presumably reflecting more widespread availability. Conclusion: Relative to other countries, Australia and New Zealand have moderate incidence rates of ESRD. The increased rates in older patients reflect similar trends throughout the world. The traditional reliance of Australia and New Zealand on home- and satellite center-based dialysis therapy and transplantation as modalities of RRT is slowly changing with this growth in older patients. Cross-sectional survey results of iron studies suggest the relationship between iron studies and erythropoietin is modified by confounding. Am J Kidney Dis 40:1122-1131. © 2002 by the National Kidney Foundation, Inc.

Changes in the incidence of end-stage renal disease due to lupus nephritis, 1982-1995.

The availability of more effective treatments for severe lupus nephritis may have influenced the rate at which end-stage renal disease (ESRD) develops in these patients. To examine changes in the incidence of ESRD due to lupus nephritis from 1982 to 1995. All patients with incident ESRD included in the US Renal Data System from 1982 to 1995 were studied. The US Renal Data System includes information on all patients who receive Medicare-reimbursed renal replacement therapy, who constitute approximately 94% of all patients with ESRD in the United States. The incidence of ESRD due to lupus nephritis in each year, standardized to the age-sex-ethnicity composition of the US general population in 1990, was computed in this serial cross-sectional study. The standardized incidence rate of ESRD due to lupus nephritis increased steadily from 1.16 cases per million person-years in 1982 to 3.08 cases per million person-years in 1995. The rate of increase was comparable to that of ESRD due to all other primary renal diseases. The incidence of ESRD due to lupus nephritis increased steadily over the 14-year study period, despite the introduction of efficacious new treatment regimens for lupus nephritis during this time.

Patterns of end‐stage renal disease in US African‐Americans

Summary: Although African‐Americans constitute only about 12.4% of the population of the United States of America (USA), they comprise over 30% of the end‐stage renal disease (ESRD) patient population. Diabetes mellitus (predominantly type 2) is the most frequently reported cause of ESRD in all racial and ethnic groups in the USA. However, hypertensive renal disease is reported as the dominant cause of ESRD in African‐Americans. In general, all racial and ethnic minority groups in the USA have greater incidence and prevalence rates of ESRD than Caucasians. However, survival probabilities in all ESRD patients, dialysis patients, and cadaveric renal allograft recipients are greater in African‐Americans than in Caucasians. the suggested reasons for these racial and ethnic disparities are discussed.

Epidemiology of end-stage renal failure in Reunion Island (results from the registry of the Indian Ocean Society of Nephrology).

End-stage renal disease (ESRD) on long-term dialysis is a substantial problem in Reunion because of the high incidence and prevalence of this disease due to non-insulin-dependent diabetes mellitus (NIDDM) and systemic arterial hypertension. In 1996 the renal study group of the Indian Ocean Society of Nephrology established a regional registry of end-stage renal failure (ESRD) on long-term dialysis. The present report summarizes data obtained from this registry. In 1996, there were 125 patients who were initiated on long-term dialysis, 657 patients on dialysis with a mean age 52 +/- 17 years, and 110 patients with a functioning kidney graft. The incidence rate of ESRD was 188 per million population (p.m.p.) and the prevalence rate of this pathology was 1155 p.m.p. The sex ratio (F/M) was 1.4/1. The two most common causes of ESRD were NIDDM in 33.6% and systemic arterial hypertension in 27.5%. The mean Kt/V value was 1.47 +/- 0.23 and the mortality rate was 8.1% per year. The results demonstrate high incidence and prevalence rates of ESRD mainly as a result of NIDDM and systemic arterial hypertension.