THE PROVISION OF RENAL REPLACEMENT THERAPY FOR ADULTS IN ENGLAND AND WALES - RECENT TRENDS AND FUTURE-DIRECTIONS

We assessed the level of provision of renal replacement therapy for ad ults in England and Wales. AII autonomous main renal units in England (n = 52) and Wales (n = 5) were surveyed in 1996. Data for England wer e compared to the 1993 National Renal Review. The acceptance rate in E ngland 1995 was 82 (80-85) per million population (p.m.p.) compared wi th 67 (65-70)p.m.p. in 1991-2. The rate in 1995 in Wales was 109 (98-1 22)p.m.p. The prevalence rate in England was 476 p.m.p. at end-1995 co mpared to 393 p.m.p. in 1993, in Wales it was 487 p.m.p. The number of main renal units in England did not rise between 1993 and 1995; capac ity was increased by use of more treatment shifts and temporary haemod ialysis stations, and by opening more satellite units. The main growth was in hospital haemodialysis. There was an uneven geographical distr ibution of services. Patients accepted were older with more comorbidit y. The use of better-quality processes of dialysis increased. The stea dy-state position for RRT will not be reached for over a decade. Healt h authorities will face continued pressure to fund increases in quanti ty and quality improvements. A stronger evidence base of the effective ness of therapies, and a national registry to monitor the equity and c ost-effectiveness of services are needed.