Epidemiology of end-stage renal disease in the Ile-de-France area: a prospective study in 1998

Background. The objective of this study was to determine the incidence and prevalence of end-stage renal disease (ESRD) requiring maintenance dialysis in the Ile-de-France district (Paris area), and the characteristics of pat ients at start of dialysis. Methods. This is a prospective epidemiological study with the cooperation o f all dialysis facilities of the Ile-de-France district (population 10.7 mi llion inhabitants as of March 1999). All consecutive ESRD patients who star ted dialysis from January 1 to December 31 1998, with demographic and clini cal characteristics, and of the total number of patients on dialysis with t heir distribution according to dialysis modality were recorded. Results. The total number of ESRD patients in 1998 was 1155, including 29 ( 2.5%) children aged less than or equal to 17 years and 86 (7.4%) returns to dialysis following kidney graft failure. Incidence of first-dialysed patie nts was 100 per million population (p.m.p.) and overall incidence, includin g returns from transplantation, was 105 p.m.p. The mean age of first-dialys ed adult patients was 59.8 +/- 16.8 years, with 21.6% aged greater than or equal to 75 years. Patients with vascular renal disease were 22.5% and thos e with diabetic nephropathy 20.6%. As a whole, 36.5% of patients were refer red to the nephrologist less than or equal to6 months before start of dialy sis, including 32.2% referred less than or equal to1 month before starting. Prevalence of cardiovascular disease was nearly twice as high in patients referred <6 months of starting dialysis than in those who benefited from ef fective nephrological care for >3 years in the predialysis period. By multi variate analysis, this difference persisted after adjustment for age and ot her confounding covariates. The total number of patients on maintenance dia lysis increased from 417 to 433 p.m.p. (a yearly 3.8% increase) from the be ginning to the end of 1998. Conclusion. This recent epidemiological study in a large French urban area indicates an annual incidence of 100 new ESRD patients p.m.p., with a high proportion of older, vascular and diabetic patients. Overall incidence, inc luding returns from transplantation, reached 108 p.m.p. Cardiovascular dise ase was significantly less frequent in patients who received nephrological care for greater than or equal to 3 years prior to start of dialysis than i n late referred patients, underlining the benefits of early nephrological m anagement of renal patients.