End-stage renal disease in Indo-Asians in the North-West of England.
BACKGROUND
The incidence of end-stage renal disease (ESRD) in England is increasing. There is a higher incidence of ESRD in British Indo-Asians than in the White population.


OBJECTIVE
To determine to what degree the increasing demand for renal replacement therapy in the UK is due to Indo-Asian patients. To study the presentation to renal services of Indo-Asian patients with ESRD and report any inequalities in initial treatment of Indo-Asian patients with ESRD compared to their White counterparts.


METHODS
Prospective, inception cohort study.


METHODS
Consecutive adult patients with ESRD who started renal replacement therapy between 1 April 2000 and 31 December 2001 in all 14 renal units serving an area from North Cheshire to South Cumbria, including Greater Manchester and Lancashire, were recruited and interviewed.


RESULTS
Of the 578 patients, 9.5% were Indo-Asian. The annual acceptance rate for renal replacement therapy was 342 per million population in Indo-Asians, compared with 91 per million population in the White population ( p < 0.001). Indo-Asian patients with ESRD were younger (median age 51 years vs. 60 yrs, p = 0.006) and more socially deprived (81% vs. 36.5% in the 5th Carstairs quintile, p < 0.001). A greater proportion of Indo-Asian patients with ESRD presented late to specialist renal services (31% vs. 19%, p = 0.03). Once adjusting for their younger age, atherosclerotic renovascular disease and/or hypertensive nephropathy was more prevalent in Indo-Asian patients (OR 4.9; p = 0.03). There was no difference in the initial mode of maintenance dialysis or the perception of choice the patients felt they had, based on their ethnicity.


CONCLUSIONS
There is a silent epidemic of ESRD in Indo-Asian patients in the North-West, possibly vascular in aetiology, in which specialist intervention is late. This suggests that Indo-Asian patients should be prioritized for early intervention strategies to reduce the burden of ESRD.
Trehan
A
A
SIRS group, Renal Unit, Manchester Royal Infirmary, Manchester and. Renal Association Standards Subcommittee, Aberdeen, UK. anutrehan@yahoo.com
Winterbottom
J
J
Lane
B
B
Foley
R
R
Venning
M
M
Coward
R
R
MacLeod
A M
AM
Gokal
R
R
D017677:Age Distribution; D001211:Asia, Western / Q000208:ethnology; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D011446:Prospective Studies; D012044:Regression Analysis; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data