Trends in incidence of treated end-stage renal disease, overall and by primary renal disease, in persons aged 20-64 years in Europe, Canada and the Asia-Pacific region, 1998-2002.
OBJECTIVE
To determine if rates of diabetic and non-diabetic end-stage renal disease (ESRD), which had been rising in young and middle-aged adults in all populations up to the mid-1990s, had started to decline, and if so, whether improvement had occurred in respect of each of the principal primary renal diseases causing ESRD.


METHODS
Poisson regression of age- and sex-standardized incidence of ESRD for persons aged 20-64 years in 18 populations from Europe, Canada and the Asia-Pacific region, for 1998-2002.


RESULTS
In persons from 12 European descent (Europid) populations combined, there was a small downward trend in all-cause ESRD (-1.7% per year, P = 0.001), with type 1 diabetic ESRD falling by 7.8% per year (P < 0.001), glomerulonephritic ESRD by 3.1% per year (P = 0.001), and 'all other non-diabetic' ESRD by 2.5% per year (P = 0.02). The reductions in ESRD attributed to hypertensive (-2.2% per year) and polycystic renal disease (-1.5% per year) and unknown diagnosis (-0.2% per year) were not statistically significant. On the other hand, the incidence of type 2 diabetic ESRD rose by 9.9% per year (P < 0.001) in the combined Europid population, although that of (principally type 2) diabetic ESRD remained unchanged in the pooled data from the four non-Europid populations.


CONCLUSIONS
Recent preventive strategies, probably chiefly modern renoprotective treatment, appear to have been effective for tertiary prevention of ESRD caused by the proteinuric nephropathies other than type 2 diabetic nephropathy, for which the continuing increase in Europid populations represents a failure of prevention and/or a change in the nephropathic potential of type 2 diabetes.
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
Jager
Kitty J
KJ
Trpeski
Lilyanna
L
McDonald
Stephen P
SP
D000328:Adult; D017677:Age Distribution; D001208:Asia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000150:complications; D005060:Europe / Q000453:epidemiology; D005921:Glomerulonephritis / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D010139:Pacific Islands / Q000453:epidemiology; D016012:Poisson Distribution; D007690:Polycystic Kidney Diseases / Q000150:complications