THE PROGNOSIS FOR END-STAGE RENAL-FAILURE IN SPINAL-CORD INJURY AND SPINA-BIFIDA - AUSTRALIA AND NEW-ZEALAND, 1970-1991

Background: The outcome of patients with end-stage renal failure (ESRF ) and spinal cord injury or disease has not been clearly documented. A ims: The aim of this study was to define the prognosis and social cons equences for patients with spinal cord injury or spina bifida (SB) tre ated for ESRF in Australia and New Zealand from 1970 to 1991. Methods: Fifty patients (two groups: 25 - spinal cord injury, 25 - SB) were id entified retrospectively by questionnaire to individual renal units. A dditional information was obtained from the Australia and New Zealand Dialysis and Transplant Registry. Dialysis and transplant history, deg ree of disability and cumulative survival with integrated treatment we re compared between the two groups. Results: Haemodialysis was the mos t common form of treatment (75.8% of total treatment time in the spina l cord injury group and 66.1% in the SB group). Home or self-care dial ysis for a period of more than six months was achieved in 68% of patie nts in each group. Ten year cumulative survival with integrated treatm ent was statistically better in the SB group (p < 0.01). In the 42% of all patients who underwent renal transplantation cumulative patient s urvival was 94% at one year and 82% at five years, with allograft surv ival being 73% and 70% respectively. In conclusion ESRF and spinal cor d injury or SB has a good prognosis in the longer term with an integra ted approach to treatment.