Dialysis treatment in Australia, 1982 to 1988

The incidence of new dialysis-dependent patients in Australia increased rapidly from 1982, due mainly to acceptance for treatment of more elderly patients. In 1988, 21% of patients beginning dialysis were 65 to 74 years old, and a further 26% were 55 to 64 years. Consequently, the prevalence of dialysis-dependent patients increased considerably during the same period, particularly in the age range 55 to 74 years. Diabetes-induced renal failure accounted for a constant low proportion of new patients, approximately 10%, which contrasted with the experience in some other countries. Hemodialysis (HD) was the more common method of treatment compared with continuous ambulatory peritoneal dialysis (CAPD) in 1988 (70% v 30%, respectively). Home dialysis treatment, HD or CAPD, supported 50% of all dialysis-dependent patients. Patient survival at 1, 2, and 5 years after initiating treatment was 89%, 78%, and 48%, respectively. Age and method of dialysis significantly influenced survival; the elderly and diabetic had a lower expectation of survival. The difference in survival of HD compared with CAPD increased with the duration of treatment, reaching 20% at 5 years (5-year survival, 59% HD; 39% CAPD). There was no evidence of increasing mortality among patients beginning treatment recently. Withdrawal from treatment represented 16% of deaths during 1988; 19% of the deaths were in the age group 65 to 74 years. The influence of the morbidity and mortality of dialysis on provision of such treatment for end-stage renal failure in the elderly population warrants an objective review of both the benefits to the individual and the availability of health care to the whole society.