title: Four decades of chronic haemodialysis: lessons from the past and implications for the future.
abstract: BACKGROUND
  There have been substantial changes in the provision of chronic haemodialysis (HD) therapy over time, yet data regarding the impact of these differences on clinical outcomes are limited.
  
  
  OBJECTIVE
  To identify factors which have significantly changed over the last 40 years in relation to patients receiving maintenance HD therapy.
  
  
  METHODS
  All 2,647 patients who were established on the chronic HD programme in Northern Ireland between 1970 and 2010 were included. Clinical data and survival outcomes were obtained from a prospectively recorded database. The study period was divided into four decades in order to assess the temporal changes.
  
  
  RESULTS
  The total number of patients receiving HD therapy has risen, and the mean age of the HD population has increased significantly (39.0 years in the 1970s vs. 66.8 years in the 2000s, p < 0.001). Diabetic nephropathy has emerged as the commonest aetiology for ESRD (0% in the 1970s to 20.3% in the 2000s, p < 0.001). The median survival of patients on HD has improved significantly over time from 5.2 months (95% CI 2.6-15.5) in the 1970s to 41.7 months (95% CI 38-45.2) in the 2000s (p < 0.0001). Factors that remained significant in determining survival were age, primary renal diagnosis, and decade of commencement of dialysis.
  
  
  CONCLUSIONS
  Survival on HD has significantly improved despite older patients with multiple co-morbidities being accepted for treatment reflecting both increased dialysis frequency and better management of cardiovascular risk factors. The increasing age of HD patients and their improved survival have implications for future planning and delivery of dialysis.
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, UK. drsiddhesh78@gmail.com
authors.forename: S M
authors.initials: SM
authors.lastname: Prabhavalkar
authors.forename: R
authors.initials: R
authors.lastname: Verghis
authors.forename: P T
authors.initials: PT
authors.lastname: McNamee
authors.forename: A E
authors.initials: AE
authors.lastname: Courtney
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003928:Diabetic Nephropathies / Q000150:complications; D058625:End Stage Liver Disease / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D006435:Renal Dialysis / Q000639:trends*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult