INCIDENCE OF NEW DIABETIC-PATIENTS ON DIALYSIS IN PIEDMONT, ITALY - MAJOR CHANGES RECORDED OVER A 10-YEAR PERIOD

Different incidence rates of new diabetic patients on dialysis are rep orted in various settings; although prevalence of this disease is ofte n considered a marker of acceptance policy, rates are thought to be in fluenced also by genetic, epidemiological and other characteristics of a population (genetic composition, age distribution, lifestyle). More over, since features of a general population are often not stable (as in the setting analysed) changes at this level may have important refl ections in the incidence of diabetics with end-stage renal disease (ES RD). In the region studied (Piedmont, northern Italy, about 4400 000 i nhabitants, 20 dialysis centres, open acceptance since the mid-1970s, yearly information on 100% of patients, gathered by a Dialysis and Tra nsplantation Registry) the incidence of diabetic patients with ESRD (3 89 cases recorded 1981-1990: 222 males, 167 females; mean age at start increasing from 55.5 years in 1981-1985 to 58.7 years in 1986-1990) d iffers according to age and sex. Incidence was higher in males, and ro se from 6.23/year patients per million population (p.m.p.) in 1981-198 2 to 12.88/year p.m.p. in 1989-1990, with a peak at age 60-69 (from 18 .46/year p.m.p. in 1981-1982, to 46.12/year p.m.p. in 1989-1990). Whil e relatively stable in the younger age groups from 1981 to 1990, incid ence increased in the elderly (males age 70-79: 7.12/year p.m.p. in 19 81-1982, 26.08/year p.m.p. in 1989-1990). As regards clinical and meta bolic patterns, at the first update, in 1986-1990, 88.3% of diabetic p atients were hypertensive or taking hypotensive drugs; albumin levels were below the normal range (< 3.5 g/dl) in 30.3%; cholesterol levels were below the normal range (< 150 mg/dl) in 16.15%. As regards entry criteria, creatinine clearances ranged from < 1 to 14 ml/min (mean val ues at first update: 3.45 +/- 2.76 ml/min). In conclusion, presentatio n of diabetic patients with ESRD is changing. The stability of inciden ce in the younger age groups confirms the appropriateness of an open a cceptance policy, at least for these ages. The increase in the elderly probably reflects the longer lifespan of diabetic patients in the ove rall population, while the influence of a hidden preselection must be further assessed. Since this cohort increasingly requires in-hospital high-tolerance treatment, future provision of dialysis needs must take into account the trend towards an increase in this high-risk elderly population.