The enigma of hypertensive ESRD: observations on incidence and trends in 18 European, Canadian, and Asian-Pacific populations, 1998 to 2002.
BACKGROUND
Despite improved treatment of hypertension and decreasing rates of stroke and coronary heart disease, the reported incidence of hypertensive end-stage renal disease (ESRD) increased during the 1990s. However, bias, particularly from variations in acceptance into ESRD treatment (ascertainment) and diagnosis (classification), has been a major source of error when comparing ESRD incidences or estimating trends.


METHODS
Age-standardized rates were calculated in persons aged 30 to 44, 45 to 64, and 65 to 74 years for 15 countries or regions (separately for the Europid and non-Europid populations of Canada, Australia, and New Zealand), and temporal trends were estimated by means of Poisson regression. For 10 countries or regions, population-based estimates of mean systolic blood pressures and prevalences of hypertension were extracted from published sources.


RESULTS
Hypertensive ESRD, comprising ESRD attributed to essential hypertension or renal artery occlusion, was least common in Finland, non-Aboriginal Australians, and non-Polynesian New Zealanders; intermediate in most European and Canadian populations; and most common in Aboriginal Australians and New Zealand Maori and Pacific Island people. Rates correlated with the incidence of all other nondiabetic ESRD, but not with diabetic ESRD or community rates of hypertension. Between 1998 and 2002, hypertensive ESRD did not increase in Northwestern Europe or non-Aboriginal Canadians, although it did so in Australia.


CONCLUSIONS
Despite the likelihood of classification bias, the probability remains of significant variation in incidence of hypertensive ESRD within the group of Europid populations. These between-population differences are not explained by community rates of hypertension or ascertainment bias.
Stewart
John H
JH
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
McCredie
Margaret R E
MR
Williams
Sheila M
SM
Fenton
Stanley S
SS
Trpeski
Lilyanna
L
McDonald
Stephen P
SP
Jager
Kitty J
KJ
van Dijk
Paul C W
PC
Finne
Patrik
P
Schon
Staffan
S
Leivestad
Torbjorn
T
Løkkegaard
Hans
H
Billiouw
Jean-Marie
JM
Kramar
Reinhard
R
Magaz
Angela
A
Vela
E
E
Garcia-Blasco
Maria J
MJ
Ioannidis
G A
GA
Lim
Y N
YN
D000368:Aged; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D048909:Diabetes Complications / Q000453:epidemiology; D016021:Epidemiologic Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D044465:White People