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Epidemiological Study of End-Stage Renal Disease Patients in Taiwan:Ten years survey
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Objective - According to the Taiwan Annual Death Report published by Department of Health, Executive Yuan, Nephritis, nephrotic syndrome and kidney disease was the eighth most common cause of death in Taiwan in 2002. Moreover, the 2002 USRDS Annual Data Report disclosed that the prevalence and incidence rate of end-stage renal disease (ESRD) patients in Taiwan ranked the second worldwide, respectively. Thus, it is the right time for us to investigate the issue on The current status of dialysis therapy and the critical issue we are facing in Taiwan, resulting in this study. The source of data in this study is mainly collected from Renal Registry database of Taiwan Society of Nephrology, and amended by the database of Annual Death Report, Department of Health, Executive Yuan, and Application form of End-stage Renal Disease entitled as Critical Illness, Bureau of National Health Insurance.
Results -The significant findings of this study are as follows: In the period of year 1990 to 2001, the prevalence and incidence rate of ESRD in Taiwan increased from 382 pmp (per million population) and 126 pmp to 1,322 pmp (3.46 times higher) and 331 pmp (2.60 times higher), respectively. Note that there is a high regional difference in these values: The prevalence rate varied from 474 pmp for King-Men and Matsu to 1,919 pmp for Tainan city (4.1 times higher). The incidence rate varied from 70 pmp for King-Men and Matsu to 486 pmp for Tainan city (6.9 times higher). The major patient cohorts that account for the increase in ESRD population were middle-aged (44~64 years old) and elderly (65 years old or older) patients, and those with diabetic nephropathy as primary renal disease. The mean age of prevalent and incident patients increased by 7.1 years and 7.2 years, respectively. The fraction of prevalent and incident elderly patients increased from 19.3% to 36.7% and from 26.8% to 45.9%, respectively. The fraction of diabetic nephropathy in prevalent and incident patients increased from 17.6% to 24.0% and from 24.7% to 35.3%, respectively. The PD penetration was significantly increased over this period, up to 7.11 % in prevalent cases and 8.81 % in incident cases, respectively, in year 2001. The penetration rate was the highest in pediatric patients, up to 48.7% in the cohort aged 19 or less. However, there is still a high regional difference in PD penetration rate, varied from 2.85 % for Tai-Tung to 12.1 % for Keelung (4.3 times higher). The first year mortality rate was increased from 14.26 % to 16.83 % or from 1,280 to 1,590 per 1,000 patient-months over past 11 years. Despite of increasing elderly and diabetic populations, ESRD patients in Taiwan were still doing well, with their 1st, 2nd, 5th and 10th year cumulative survival rate at 85.1 %, 74.6 %, 53.7 %, and 35.0 %. The main causes of death were cardiovascular disease (42 % in year 2001) and infection (24 %). The significant risk factors for mortality, adjusted by Cox Hazard Model, were age, male gender, diabetic nephropathy as primary renal disease, co-morbidities (hypertension, cardiovascular disease), and severe anemia (Hct less than 30 %). However, male gender and hypertension were not risk factors for death in peritoneal dialysis patients.
Conclusion Based on the growth trend of ESRD patients in Taiwan , the projected number of prevalent and incident patients is expected to double from year1998 to 2010. Moreover, the patient population on long duration of dialysis is also increasing, 13.8 % of patients being dialyzed for 10 years, and 3.0 % being treated for 15 years. Consequently, more and more dialysis-related issues regarding medical practice, public health, epidemiology, and medical economics will soon emerge. This study is to explore the current status and trend of dialysis therapy in Taiwan. We enthusiastically invite the experts of these special fields to work out an integrated dialysis care together. In addition, setting up a task force on the prevention and integrated management of chronic kidney disease is essential to further reduce the growth of ESRD incidence and the consequent huge economic burden in Taiwan.
Keywords: ESRD.HD.PD.Dialysis Quality