Epidemiology of terminal renal insufficiency treated by dialysis and therapeutic options in a population of 400,000 inhabitants (1975-1986)
Simon, P.; Ang, K.S.; Cam, G.; Ramée, M.P.
Nephrologie 8(6): 293-299
1987
ISSN/ISBN: 0250-4960 PMID: 3330578 Document Number: 301338
Since January, 1, 1976, epidemiologic study of renal diseases has been leading in a French rural area of 400,000 inhabitants located in north coast of Britanny. Annual incidence of end stage renal failure (ESRF) treated by dialysis increased of 25% when two consecutive periods of five years each were compared: A (1976-1980) 46 per 10(6) inhabitants, B (1981-1985) 62 per 10(6) inhabitants. In 1986, the progression was confirmed: 96 per 10(6). At the time of the beginning of dialysis treatment, mean age (+/- SD) was not different between two periods: 53 +/- 17 yrs (A) vs 51 +/- 17 yrs (B) but it increased in 1986: 61 +/- 14 yrs. Sex ratio (M/F) progressed from 1 (A) to 1.75 (B). The study of causes of ESRF showed a net increase of secondary renal diseases (diabetes, amyloidosis), interstitial nephropathies due to obstructive uropathy (lithiasis) and drugs. For the period B, 91% of primary glomerulonephritis reaching ESRF had had renal biopsy. Idiopathic IgA nephropathy was the first cause of ESRF (13.7%, 0.85 pts/100,000) before diabetes (12%, 0.75/100,000), Polycystic disease (11.3%, 0.70/100,000), reflux nephropathy (9.6%, 0.60/100,000), focal and segmental glomerulosclerosis (8.8%, 055/100,000). Prevalence of ESRF for primary glomerulonephritis was calculated to 20.6% and according to the histological type to 28.3% for idiopathic IgA nephropathy, 34.8% for local and segmental glomerulosclerosis, 40% for idiopathic crescentic glomerulonephritis and only 6.6% for membraneous nephropathy. In the studied area, 58% of patients were treated out of hospital (at home or in self-dialysis units) whose 46% by hemodialysis and 12% by CAPD.