Only unbiased estimates of end-stage renal disease (ESRD) incidence and trends are useful for disease control—identification of risk factors and measuring the effect of intervention.Methods
Age- and sex-standardized incidences (with trends) were calculated for all-cause and diabetic/non-diabetic ESRD for persons aged 0–14, 15–29, 30–44 and 45–64 years in 13 populations identified geographically, and six populations identified by ethnicity.Results
The incidence of ESRD varied most with age, ethnicity and prevalence of diabetes. All non-Europid populations had excess ESRD, chiefly due to rates of type 2 diabetic ESRD that were greater than accounted for by community prevalences of diabetes. Their rates of non-diabetic ESRD also were raised, with contributions from most common primary renal diseases except type 1 diabetic nephropathy and polycystic kidney disease. The ESRD rates generally were low, and more similar than different, in Europid populations, except for variable contributions from type 1 (high in Finland, Sweden, Denmark and Canada) and type 2 (high in Austria and Canada) diabetes. In Europid populations during 1998–2002, all-cause ESRD declined by 2% per year in persons aged 0–44 years, and all non-diabetic ESRD by a similar amount in persons aged 45–64 years, in whom diabetic ESRD had increased by 3% per year.Conclusions
Increased susceptibility to type 2 diabetes and to kidney disease progression characterizes excess ESRD in non-Europid peoples. The decline in all-cause ESRD in young persons, and non-diabetic ESRD in the middle-aged, probably reflects improving management of progressive renal disease.