Subject(s)
Biomedical Research/history , Kidney Diseases/history , Nephrology/history , Acid-Base Equilibrium , Acidosis, Renal Tubular/history , Fanconi Syndrome/history , History, 20th Century , History, 21st Century , Kidney Diseases/genetics , Kidney Diseases/physiopathology , Renal Tubular Transport, Inborn Errors/history , United KingdomABSTRACT
BACKGROUND: The aim of this study is to investigate reasons for the large reported differences in renal replacement therapy (RRT) incidence between Germany and England and Wales (E&W). METHODS: Age- and sex-standardized incidence rates were calculated at day 0, day 90, and day 180 by using registry data, and early RRT mortality was studied as an indicator of ascertainment differences. Nationally representative health survey data were analyzed to provide general population prevalence data for major chronic kidney disease risk factors: hypertension, diabetes, vascular disease, obesity, and smoking. Resource data were collected from routine sources and national surveys, and literature searches were performed to explore variation in chronic kidney disease prevalence, late referral, early start, and nondialytic therapy. RESULTS: The gap in RRT incidence between Germany and E&W increased after adjusting for differences in early mortality. The standardized day-90 incidence rate ratio was 1.79 (193.0 per million of the adult population [pmap] in Germany and 107.5 pmap in E&W) diabetes and vascular disease explained 79% of this difference. Diabetes, ischemic heart disease, and hypertension were 1.85-, 1.24-, and 1.18-fold more prevalent in Germany, whereas rates of hypertension control were 0.54-fold lower (20% versus 37% in England). Ischemic heart disease mortality rates were lower in Germany. CONCLUSION: Much of the difference in RRT incidence between Germany and E&W is explained by a greater prevalence of diabetes, hypertension, and vascular disease in the German general population, particularly those older than 65 years, and lower competing mortality risk.
Subject(s)
Kidney Failure, Chronic/epidemiology , Adolescent , Adult , Aged , England/epidemiology , Female , Germany/epidemiology , Humans , Incidence , Kidney Failure, Chronic/therapy , Male , Middle Aged , Registries , Renal Replacement Therapy , Wales/epidemiologyABSTRACT
BACKGROUND: There is concern about the rising prevalence of type 2 diabetes mellitus and of the resultant nephropathy. This study uses data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry to provide information on the epidemiology and outcome of renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetic nephropathy (DN). METHODS: Data from the following 10 registries: Austria, French-speaking Belgium, Denmark, Finland, Greece, Norway, Scotland (UK), Catalonia (Spain), Sweden, and The Netherlands were combined. Average annual changes (%) were estimated by Poisson regression. Analyses of mortality were performed by Cox regression. RESULTS: An increase in patients with type 2 DN entering RRT has been observed (+11.9% annually, P < 0.05), while large differences in RRT incidence in this disease continue to exist between countries in Europe. There was a reduction in mortality during the first 2 years on dialysis therapy among patients with type 2 DN (AHR 0.96, 95%CI 0.94-0.97 annually). The mortality among transplant recipients decreased for both type 1 DN and nondiabetic ESRD (non DN) within the 1995-1998 cohort (type 1 DN: AHR 0.49, 95% CI 0.35-0.68; non DN: AHR 0.79, 95% CI 0.69-0.90) compared to the 1991-1994 cohort. CONCLUSION: This report has shown that during the last decade there has been a marked increase in the incidence of RRT for type 2 DN. Survival analysis showed that over the period 1991-1999 the mortality rates of all dialysis patients and of type 1 diabetic and nondiabetic renal transplant recipients have fallen.
