Between 1982 and 1992, the number of new patients taken yearly onto renal replacement therapy (RRT) increased from 42 to 62 per million population, By December 1992, approximately 22,800 patients (401 per million population) were alive under some mode of RRT. The number of patients aged 15 to 34 years starting RRT slumped from 20% to 11%, whereas that of patients aged greater than or equal to 75 years tripled (5% to 15%). The proportion of patients with primary glomerulopathy decreased (25% to 19%) whereas that of patients with vascular diseases or diabetic nephropathy increased notably (14% to 21% and 7% to 13%, respectively). An ever increasing proportion of patients were treated with in-center or limited-care hemodialysis, whereas home hemodialysis steadily declined and continuous ambulatory peritoneal dialysis (CAPD) was applied to 7% of patients in 1991, The average number of weekly hemodialysis hours tended to decrease, particularly for patients aged greater than or equal to 75 years. At best, in 1991, approximately 2,000 renal transplants (36 per million population) were performed yearly, but unfortunately, this figure is steadily declining. Five- and 10-year overall survival rates were similar in young patients who were treated with center or home hemodialysis and those who underwent transplantation. Overall survival is rather poor in diabetic patients, 38% and 17% at 5 and 10 years, respectively, but best in those with a functioning first kidney transplant (69% at 10 years). Cardiac causes accounted for one third of all deaths in hemodialysis patients, vascular causes for 15% to 18%, and infectious causes for 10%. Deaths of cardiac or infectious origin were highest in diabetic patients when compared with those recorded in patients with standard (nonsystemic) and vascular renal diseases. (C) 1995 by the National Kidney Foundation, Inc.
