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Exploring the differences in epidemiology of treated ESRD between Germany and England and Wales

Caskey, Fergus J., Schober-Halstenberg, Hans-Jürgen, Roderick, Paul J., Edenharter, Günter, Ansell, David, Frei, Ulrich and Feest, Terry G. (2006) Exploring the differences in epidemiology of treated ESRD between Germany and England and Wales American Journal of Kidney Diseases, 47, (3), pp. 445-454. (doi:10.1053/j.ajkd.2005.12.026).

Record type: Article


Background: The aim of this study is to investigate reasons for the large reported differences in renal replacement therapy (RRT) incidence between Germany and England and Wales (E&W).
Methods: Age- and sex-standardized incidence rates were calculated at day 0, day 90, and day 180 by using registry data, and early RRT mortality was studied as an indicator of ascertainment differences. Nationally representative health survey data were analyzed to provide general population prevalence data for major chronic kidney disease risk factors: hypertension, diabetes, vascular disease, obesity, and smoking. Resource data were collected from routine sources and national surveys, and literature searches were performed to explore variation in chronic kidney disease prevalence, late referral, early start, and nondialytic therapy.
Results: The gap in RRT incidence between Germany and E&W increased after adjusting for differences in early mortality. The standardized day-90 incidence rate ratio was 1.79 (193.0 per million of the adult population [pmap] in Germany and 107.5 pmap in E&W); diabetes and vascular disease explained 79% of this difference. Diabetes, ischemic heart disease, and hypertension were 1.85-, 1.24-, and 1.18-fold more prevalent in Germany, whereas rates of hypertension control were 0.54-fold lower (20% versus 37% in England). Ischemic heart disease mortality rates were lower in Germany.
Conclusion: Much of the difference in RRT incidence between Germany and E&W is explained by a greater prevalence of diabetes, hypertension, and vascular disease in the German general population, particularly those older than 65 years, and lower competing mortality risk.

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Published date: 2006


Local EPrints ID: 24290
ISSN: 0272-6386
PURE UUID: 7e16837f-4f5f-4f62-8bdd-40c44e57a074
ORCID for Paul J. Roderick: ORCID iD

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Date deposited: 30 Mar 2006
Last modified: 17 Jul 2017 16:14

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Author: Fergus J. Caskey
Author: Hans-Jürgen Schober-Halstenberg
Author: Günter Edenharter
Author: David Ansell
Author: Ulrich Frei
Author: Terry G. Feest

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