[Epidemiology of care demands]

SOME FIGURES: Terminal renal failure (TRF) is a major public health problem in France in view of its increasing incidence (110 pmi/year), prevalence (700 pmi) and the costs of treatments supplied. In France, more than 6,500 new patients started treatment for TRF in 2001; around 42,000 patients with renal failure have been treated. The mean cost of treatment per patient is estimated to be of 350 KF per annum for dialysis, 450 KF for transplantation the first year and 50 KF per annum thereafter. Hence, more than 10 billion francs are spent every year on treating TRF, i.e., 1.5% of the Health Scheme. However, these costs do not include expensive treatments (erythropoietin), transport or hospitalisation. RECENT TENDENCIES: Our information system concerning TRF is fragmented and not coordinated. Identification of the cases is incomplete, their declaration is not always systematic and the quality control of the data has not been formalized. Nonetheless, major tendencies can be identified. The notable facts of the last 10 years are an aging TRF population and an increase in associated comorbidity. The diseases leading to TRF are changing. Vascular nephropathies predominate; ischemic renal diseases have become the first cause of TRF in elderly patients. The incidence of type 2 diabetes is increasing and strangely in the French overseas territories. Glomerular nephropathies are the third cause of TRF, particularly in the young. However, compared with other causes, their prevalence is decreasing. INSUFFICIENCIES: The morbidity and mortality with dialysis is dominated by cardiac and vascular causes. Renal transplantation has stagnated; the waiting lists increase and donations are insufficient. Conversely, transplantation survival is progressing. In a second part, we will examine the elements of health strategy necessary to adapt the supply of care and the organization of preventive measures.