A PROSPECTIVE-STUDY OF WARD REFERRALS FOR RENAL-DISEASE AT A JAMAICANAND A UNITED-KINGDOM HOSPITAL

Seventy ward referrals for renal disease were prospectively studied at each of two tertiary hospitals: University Hospital of the West Indie s (UHWI), kingston, Jamaica and Nottingham City Hospital (NCH), Englan d At UHWI, the referral population was significantly younger, 89% bein g less than 60 years of age compared to 40% at NCH (p < 0.05). The lea ding cause of acute renal failure (ARF) at UHWI was systemic lupus ery thematosus (SLE) followed by acute tubular necrosis (ATN). The leading causes of ARF at NCH were ATN and obstructive uropathy. Primary renal disease and diabetes mellitus were the major causes of end-stage rena l disease (ESRD) al both centres, followed by SLE and hypertension at UHWI and renovascular disease and chronic pyelonephritis at NCH. Nephr otic syndrome occurred more frequently at UHWI than at NCH but the num bers were small (p < 0.05). Mortality rates were similar among patient s with ARF and nephrotic syndrome at bath centres, but were higher for patients with chronic renal failure (CRF) at UHWI than at NCH (p < 0. 05). Continuous ambulatory peritoneal dialysis (CAPD) mrs a frequent m ode of renal replacement therapy at NCH (76% v 19% an haemodialysis). Al UHWI, CAPD was not available and 45% of patients with ESRC, were no t offered maintenance dialysis because of inadequate facilities. The m ajor difference in management and outcome between the two centres occu rred in cases with CRF, suggesting that survival in patients with CRF in Jamaica could be improved if this therapeutic modality was availabl e.