END-STAGE RENAL-FAILURE DUE TO ANALGESIC NEPHROPATHY, ITS CHANGING PATTERN AND CARDIOVASCULAR MORTALITY

The changing pattern of prevalence and age distribution of analgesic n ephropathy as a cause of end-stage renal failure (ESRF) in patients on RRT was analysed using the EDTA-ERA Registry's files. Comparing 1990 to 1981, the percentage of patients with analgesic nephropathy decreas ed in many European countries and the Registry's average came down fro m 3 to 2%. The highest prevalence was noted for Switzerland, which sho wed a decrease from 28 in 1981 to 12% in 1990. During the same interva l the age distribution shifted to the right with an increase in median age from 57 to 63 at start of RRT for analgesic nephropathy. In Switz erland the age-specific acceptance rate to RRT for patients with analg esic nephropathy decreased to less than 1/3 in the age cohorts below 5 5 but increased in those aged 65 or older. This increase in the elderl y cohorts appeared to be related to the growing acceptance rate to RRT of elderly patients in general rather than to an increasing incidence of ESRF due to analgesic nephropathy. Mortality in general and death rates due to cardiovascular causes were found not to differ in RRT pat ients with analgesic nephropathy from that of other standard primary r enal diseases (excluding diabetic nephropathy and systemic diseases). Some 20 years after withdrawal of phenacetin from the analgesic market , analgesic nephropathy all but disappeared as a cause of ESRF in Swed en and Denmark, and the same may be expected to occur in countries lik e Switzerland, Belgium, and others in the not too far distant future.