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.