Equity of renal replacement therapy utilization: a prospective population-based study

This 1-year prospective survey assessed the incidence and characteristics o f all patients starting renal replacement therapy (RRT) for end-stage renal disease in Scotland, and whether there is equity of utilization of RRT in terms of age, domicile and social circumstance. In the year studied, 104 pa tients per million population (533 patients) started RRT (390 per million p opulation aged 65-75). In 23.5% the cause of ESRD could not be determined. Diabetes was the single most frequently identified cause (16%). The require ment for RRT rose with age, but over the country as a whole, patients aged over 75 years were under-represented. The majority of health boards provide d RRT at a rate within 20% of the national rate. There was no difference in the median age at starting RRT between health boards. The spectrum of soci al deprivation of patients starting RRT was the same as that of the general population. There was no evidence that social deprivation influences accep tance on to the RRT program, although the relationship between ESRD and dep rivation is complex. The utilization of RRT exceeded the minimum rate recom mended by the Renal Association, although there was fluctuation between hea lth board areas. The national requirement for resources to provide RRT is l ikely to rise further to care for an increasingly elderly population.