Incidence of uraemia and requirements for maintenance haemodialysis

Area of Science:

• Nephrology
• Geriatric Medicine
• Biochemistry

Background:

• Elevated blood urea levels (≥100 mg/100 ml) were observed in 487 patients over a three-year period (1966-1968) at a 400-bed hospital.
• The majority of these patients were elderly, with 90% aged 50 and over, 79% aged 60 and over, and 52% aged 70 and over.

Purpose of the Study:

• To investigate the causes and prevalence of renal failure in a hospital population.
• To assess the suitability of patients for renal replacement therapy, including maintenance hemodialysis and renal transplantation.

Main Methods:

• Analysis of biochemistry laboratory records for patients with blood urea ≥100 mg/100 ml.
• Review of case notes for patients admitted with renal failure during 1966-1967 and younger patients (<60) in 1968.
• Consensus among three observers on the most likely cause of renal failure in available case notes.

Main Results:

• Prerenal factors (60%) and acute tubular necrosis (80%) were the most common causes of raised blood urea.
• Obstructive uropathy (12%) and intrinsic renal disease (20%) were less frequent causes.
• Renal failure was frequently precipitated by conditions such as cardiac failure, infections, and shock, particularly in older individuals.

Conclusions:

• Renal failure in this population is often associated with prerenal factors and acute tubular necrosis, especially in the elderly.
• The estimated rate of suitability for renal replacement therapy (dialysis or transplantation) was low, approximately 39 per million per year for those under 60.