Has the yearly increase in the renal replacement therapy population ended?

Abstract

The recent decline in the number of new patients undergoing dialysis and transplantation in the United Statesmay be linked to a reduction in the incidence of earlystart dialysis, defined as the initiation of renal replacement therapy (RRT) at an estimatedGFR$10 ml/min per 1.73m2.We examined themost recent data fromthe U.S. Renal Data System to determine how this trend will affect the future incidence of ESRD in the United States. The percentage of early dialysis starts grew from 19% to 54% of all new starts between 1996 and 2009 but remained stable between 2009 and 2011. Similarly, the incident RRT population increased substantially in all age groups between 1996 and 2005, with the largest increase occurring in patients aged $75 years. Early dialysis starts accounted formost of the increase in the incident RRT population in all age groups during this time period, and between 2005 and 2010, the increase slowed dramatically. Although the future incident RRT population will be determined in part by population growth, these results suggest that later dialysis starts and greater use of conservative and palliative care, whichmay improve quality of life for elderly patients with advanced renal failure, will continue to attenuate the increase observed in previous years. Copyright © 2013 by the American Society of Nephrology.