Prevalence Of Renal Replacement Therapy Research Articles

Incidental renal artery stenosis in peripheral vascular disease: A case for treatment?

Renal artery stenosis (RAS) is frequently encountered as an incidental finding in peripheral vascular disease. We assessed whether revascularization is indicated to prevent the practical consequences of end-stage renal failure, that is, the need for renal replacement therapy. In a retrospective study, a cohort of consecutive patients was followed who had undergone angiography 8 to 10 years previously for peripheral artery disease. Patients with untreated incidental RAS of > or =50% diameter stenosis (68.8 +/- 9.8 years, mean +/- SD) were compared with regard to the prevalence of renal replacement therapy to controls without RAS who were matched for age and gender. RAS was present in 126 of 386 evaluable patients (33%). None of these patients required renal replacement therapy during the 10-year follow-up. Serum creatinine values remained stable during follow-up. Incidental RAS is frequently seen in patients with peripheral vascular disease. If left untreated, incidental RAS seems not to result in end-stage renal failure or in a need for renal replacement therapy. Revascularization with the aim to prevent end-stage renal failure seems less indicated, and further prospective studies are indicated to elucidate this issue.

Renal replacement therapy in Latin America

Renal replacement therapy in Latin America. The Latin American Society of Nephrology and Hypertension (SLANH) Dialysis and Renal Transplantation Registry was created in October 1991 as a multinational, mainly voluntary registry. Annual data reports on the incidence, prevalence and outcome of renal replacement therapy (RRT) in the region have been issued. The RRT prevalence increased from 123 per million population (pmp) in 1992 to 180 pmp in 1997, and the acceptance rate was 57 pmp in 1997. Among incident patients, 32.8% were older than 65 years and 24% had diabetic nephropathy. Mortality rate in dialysis patients was 152 deaths per 1000 patient-years at risk. The low acceptance rate is mainly a consequence of economic and health care system difficulties in Latin American countries. A large number of patients in this region do not reach RRT due to restricted availability and difficulties in referral. There are important demographic, socioeconomic, acceptance availabilities, and questionnaire response rate heterogeneity among Latin American countries. Because of this heterogeneity, it is very difficult to compare data obtained from different countries of this region of the world. To overcome this difficulty is the critical challenge for the future activity of the SLANH Registry.

Improved survival in renal replacement therapy in Europe between 1975 and 1992. An ERA-EDTA Registry study.

The prevalence of Renal Replacement Therapy (RRT) is rising steadily, worldwide and in Europe. One reason for this is an increasing number of patients starting RRT, but improving survival on RRT may also be contributing. In an ERA-EDTA Registry study we have examined survival of patients with Standard Primary Renal Disease, or Diabetes, aged 20 to 75 years, who started RRT with haemodialysis (HD) or peritoneal dialysis (PD) between 1975 and 1992. Altogether close to a quarter of a million patients were included in the analysis which included conventional survival analysis of comparable subgroups of the whole cohort as well as Cox regression. After accounting for age, mode of initial treatment, and diagnosis, an improvement in survival of RRT patients was evident. From Cox regression it was calculated the risk for death decreased by about 5% annually during the time period 1975 1992. Patients who started RRT using PD experienced a higher mortality than those starting with HD. According to Cox regression the relative risk ratio for death was 1.25 for the whole period. The difference in survival between patients starting with PD or HD diminished during the observation period (1975-1992). The survival prospects of a patient presenting with end stage renal disease were considerably better in the early 1990s compared to the mid 1970s. This is reassuring despite the fact that mortality on RRT remains high. The higher mortality of RRT patients who started with PD is probably an 'historical' observation as the techniques of this treatment modality have improved considerably since the 1980s which was the time period from which came most of the data for the analysis.

Geographical variation in the referral of patients with chronic end stage renal failure for renal replacement therapy

The number of dialysis units per million population is low in the UK by comparison with other European countries, and this may affect the referral of patients for renal replacement therapy. We used a Poisson regression model to analyse the spatial distribution of all 539 adult patients resident in south-west Wales (Dyfed and West Glamorgan) who started chronic renal replacement therapy between April 1985 and March 1994. Controlling for patient age, population distribution, socio-economic variables and ethnic group, there was a significant negative relationship between referral rates and distance of residence from the renal unit for patients aged over 60 years, but not for younger patients. The prevalence of renal replacement therapy rose from 128 to 454 per million in Dyfed, and from 188 to 647 per million in West Glamorgan, between 1985 and 1995.

Population need for renal replacement therapy in Thames regions: ethnic dimension

To determine the use of renal replacement therapy by ethnic origin and to ascertain the variation in provision of such therapy and to relate this to the distribution of ethnic minority populations. Analysis of retrospective and cross sectional data from 19 renal units. All four Thames regional health authorities. Patients resident in the Thames regions who were accepted as new patients for renal replacement therapy during 1991 and 1992 and the patients who were already undergoing such treatment between December 1992 and April 1993. Rates of acceptance for and prevalence of renal replacement therapy among white, black, and Asian people. The average annual acceptance rates per million in 1991-2 were 61 for white people, 175 for black people, and 178 for Asians, and the prevalences per million were 351, 918, and 957 respectively. The relative risks increased with age. A threefold increase in the acceptance rate occurred in people aged under 55 in both the black and Asian populations, suggesting that the higher rates are probably not due to factors related to access alone. Treatment rates varied considerably among districts, reflecting both the distribution of ethnic minority populations and access to services. Black and Asian people receive and have a greater need for renal replacement therapy, and the need will increase as these populations age. These findings have important implications for the provision of renal services in districts with a high proportion of ethnic minorities and for the management of diabetes mellitus and hypertension, two important causes of end stage renal failure in these populations.