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A regional end-stage renal disease program: twelve years' experience
Annals of Internal Medicine
|September 1, 1980
Summary
End-stage renal disease (ESRD) patient survival is higher with transplantation and home dialysis compared to center dialysis. Increasing ESRD patient numbers strain cadaveric organ availability, impacting transplantation rates.
Area of Science:
- Nephrology
- Public Health
- Transplantation Medicine
Background:
- End-stage renal disease (ESRD) patient numbers and age are increasing.
- Treatment modalities for ESRD include transplantation, home dialysis, and center dialysis.
- Cadaveric donors are the primary source for kidney transplantation, supplying 71% of organs.
Purpose of the Study:
- To analyze patient survival rates across different ESRD treatments.
- To assess the impact of increasing patient populations on transplantation rates.
- To project future treatment needs for ESRD patients.
Main Methods:
- Retrospective analysis of 558 ESRD patients treated by December 31, 1978.
- Categorization of patients by treatment: transplantation (150), home dialysis (109), and center dialysis (299).
- Comparison of survival rates and mortality across treatment groups.
Main Results:
- Overall survival was 328 patients (58.8%).
- Survival rates: 25% for transplantation, 15% for home dialysis, and 59% for center dialysis.
- Higher mortality observed in center dialysis patients compared to transplant and home dialysis patients.
- Declining transplantation rate due to increased patient numbers without a corresponding rise in cadaveric organs.
Conclusions:
- Home dialysis and transplantation can manage approximately 50% of new ESRD patients.
- Center dialysis remains the dominant treatment but has higher mortality.
- Projected equilibrium for ESRD treatment requires 632 patients per million, with 500 needing center dialysis and 100 stations per million population.