Læknablaðið - 15.01.1999, Page 11

LÆKNABLAÐIÐ 1999; 85
9
Meðferö viö lokastigsnýrnabilun
á íslandi 1968-1997
Páll Ásmundsson, Runólfur Pálsson
Ásmundssun P, Pálsson R
Treatment of end-stage renal disease in Iceland
1968-1997
Læknablaðið 1999; 85: 9-24
Objective: Renal replacement therapy for end-stage
renal disease (ESRD) has been provided in Iceland
since 1968 when hemodialysis was begun. Kidney
transplantation in Icelandic patients has been per-
formed abroad since 1970 mainly in Copenhagen,
Gothenburg and Boston. The purpose of this retro-
spective study was to determine the changes in inci-
dence, prevalence, and outcome of ESRD treatment
during the period 1968-1997 and compare the results
with other ESRD programs, mainly in the Nordic
countries.
Material and methods: Included in this study were
all patients who began renal replacement therapy for
ESRD during the study period and remained on
therapy for at least six weeks. Data were obtained
from the registry of ESRD, compiled by the Dialysis
Service of the National University Hospital. The data
were used to determine the annual incidence and
prevalence of treated ESRD. Changes in parameters,
such as age at the beginning of renal replacement
therapy, gender distribution, causes of ESRD, treat-
ment modalities, and survival were evaluated. An-
nual mortality rate was calculated as deaths per 100
life-years. Comparison of means was done by the
two sample t-test, survival was estimated by the Kap-
lan-Meier method and survival differences were de-
termined with the Mantel-Cox test.
Results: A total of 201 patients began therapy for
Frá blóöskilunardeild og lyflækningadeild Landspítalans.
Fyrirspurnir, bréfaskipti: Páll Ásmundsson, blóðskilunar-
deild Landspítalans, 101 Reykjavík; sími 560 1280, bréf-
sími: 560 1287, netfang: pallas@rsp.is
Lykilorö: lokastigsnýrnabilun, skilunarmeöferð, nýrna-
ígræösla.
ESRD during this 30 year period. The number of
patients beginning renal replacement therapy in each
of the three consecutive decades was 27, 59 and 115,
respectively, which corresponds to 12.8, 25.1 and 44
per million population per year. The mean age rose
throughout the study period and was 54.8 in the final
decade. The prevalence per million population was
72 in 1977, 182 in 1987 and 356 in 1997. Diabetic
nephropathy was not observed as a cause of ESRD
until the last decade when it accounted for 12% of
new patients. Hemodialysis was the sole dialysis
modality until 1985. Peritoneal dialysis has since
provided approximately one third of the dialysis
treatment. The number of renal transplants was 13,
30 and 58 for each decade, respectively. At the end of
1997 there were 59 functioning allografts and of these
45 were from living donors. Patients with a functio-
ning allograft were 70% of all ESRD patients at the
end of 1997. Allografts came predominantly frorn
cadaveric donors during the first two decades but
living donors were 65% in the final decade. The five
year survival of transplanted patients (81%) was
markedly superior to that of dialyzed patients (16%).
The annual mortality rate declined for the whole
period, during the last decade it was 10.7 per 100
life-years for all patients, 27.9 for hemodialysis
patients, 15.3 for peritoneal dialysis patients and 2.1
for transplanted patients. Death was mainly from
cardiovascular causes and infections.
Conclusions: There has been marked increase in the
incidence and prevalence of treated ESRD in Iceland
during the last 30 years. However, the incidence is
low compared to the other Nordic countries, mainly
as a result of low incidence of ESRD due to glomer-
ulonephritis and diabetic nephropathy. Nearly half
the ESRD population has received a renal transplant.
Only Norway has a higher prevalence of transplanted
patients among the ESRD pool. The percentage of
living donor grafts among the transplanted patients is
the highest the authors are aware of. Five year patient
survival and renal allograft survival in Iceland were
comparable to other countries.
Keywords: end-stage renal failure, renal replacement
therapy, kidney transplantation.