Epidemiology

The 1996 annual data report of the United States Renal Data System (USRDS) noted there were 73,091 new cases of ESRD (incidence, 2.7 per 10,000), with 283,932 patients being treated for ESRD (prevalence, 10.4 per 10,000) during that year.1 The most common age group with ESRD is the 45-to-64 age group, representing 38.7 percent of patients. African Americans make up a disproportionate number of ESRD patients, accounting for 32.3 percent, while making up just 12.2 percent of the US population.

USRDS projects that the incidence of ESRD is growing by 6 to 7 percent per year. An expanding incidence and life span will result in an expected increasing prevalence of ESRD of 8 to 9 percent per year. USRDS projects similar growth rates of ESRD for African Americans and Caucasians but predicts a two times greater growth rate for Native Americans and Asians and Pacific Islanders. The highest growth rate by age occurs in the over-75 age group.

Diabetes mellitus is the most common disease causing ESRD, accounting for 32.5 percent of patients, followed by hypertension (24.5 percent), glomerulonephritis (17.7 percent), and cystic kidney disease (4.7 percent).

The utilization of RRT for ESRD is divided into 62 percent on dialysis therapy and 38 percent with renal transplants. 2 Of the patients on dialysis, 83 percent are on HD and 17 percent on PD. African Americans have significantly lower rates of renal transplantation and PD than do Caucasians and Asians and Pacific Islanders. Pediatric patients ages 0 to 19 have significantly higher rates of renal transplantation and PD than do other age groups.

Overall, ESRD patients have a life expectancy of between 19 and 47 percent of the expected remaining years of life for age-, sex-, and race-matched control subjects without ESRD.3 One-, two-, and five-year survival rates for ESRD are 78.2, 62.7, and 29.3 percent, respectively. Cardiac causes account for approximately 50 percent of all cases of ESRD death.4 Infectious causes of death occur in 25 percent of patients in the 20- to 44-year-old age group. Cerebrovascular events make up 6 percent of ESRD deaths, with malignancy accounting for another 1 to 4 percent. Approximately 20 percent of dialysis patients withdraw from therapy before death. Patients over 65 years of age have the highest withdrawal rate, 25 percent. The increasing incidence of withdrawal with age is linked to an increasing severity of comorbid conditions affecting patients' quality of life on RRT.

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