Geographic, ethnic, age-related and temporal variation in the incidence of end-stage renal disease in Europe, Canada and the Asia-Pacific region, 1998-2002.
BACKGROUND
Only unbiased estimates of end-stage renal disease (ESRD) incidence and trends are useful for disease control-identification of risk factors and measuring the effect of intervention.


METHODS
Age- and sex-standardized incidences (with trends) were calculated for all-cause and diabetic/non-diabetic ESRD for persons aged 0-14, 15-29, 30-44 and 45-64 years in 13 populations identified geographically, and six populations identified by ethnicity.


RESULTS
The incidence of ESRD varied most with age, ethnicity and prevalence of diabetes. All non-Europid populations had excess ESRD, chiefly due to rates of type 2 diabetic ESRD that were greater than accounted for by community prevalences of diabetes. Their rates of non-diabetic ESRD also were raised, with contributions from most common primary renal diseases except type 1 diabetic nephropathy and polycystic kidney disease. The ESRD rates generally were low, and more similar than different, in Europid populations, except for variable contributions from type 1 (high in Finland, Sweden, Denmark and Canada) and type 2 (high in Austria and Canada) diabetes. In Europid populations during 1998-2002, all-cause ESRD declined by 2% per year in persons aged 0-44 years, and all non-diabetic ESRD by a similar amount in persons aged 45-64 years, in whom diabetic ESRD had increased by 3% per year.


CONCLUSIONS
Increased susceptibility to type 2 diabetes and to kidney disease progression characterizes excess ESRD in non-Europid peoples. The decline in all-cause ESRD in young persons, and non-diabetic ESRD in the middle-aged, probably reflects improving management of progressive renal disease.
Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin, New Zealand. margaret.mccredie@stonebow.otago.ac.nz
Stewart
J H
JH
McCredie
M R E
MR
Williams
S M
SM
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000208:ethnology; D018450:Disease Progression; D004198:Disease Susceptibility; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000208:ethnology; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012042:Registries; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D013997:Time Factors