TRENDS IN THE INCIDENCE OF END-STAGE RENAL-FAILURE DUE TO HYPERTENSION AND VASCULAR-DISEASE IN AUSTRALIA, 1972-1991

Background: Despite the known protective effects upon renal function o f lowering blood pressure in primary chronic renal disease, diabetes a nd malignant hypertension, the number of patients entering dialysis an d transplantation programmes with renal failure due to hypertension or vascular disease remains high. Aims: To analyse the trends in inciden ce of arteriopathic end-stage renal failure. Methods: Calculation of m ean annual age- and sex-specific rates (by decade) and truncated age-s tandardised rates for entry into Australian end-stage renal failure pr ogrammes in the period 1972-1991. Statistical analysis by chi-squared test, assuming a Poisson distribution of cases. Results: End-stage ren al failure attributed primarily to hypertension or vascular disease fe ll to less than half its former level over the period of observation i n persons aged 15-54 years. This change has occurred only in the diagn ostic category 'malignant hypertension'. Trends in persons aged 55 yea rs and over are more difficult to analyse because of changing criteria for entry into renal failure programmes, but there has been no indica tion of any fall in incidence. Conclusions: The aetiology and patholog y of arteriopathic renal failure is diverse, with different patterns i n young and old adults. The formerly common pathology in young adults is largely preventable by modern antihypertensive therapy, while arter iopathic renal disease in older persons is not.