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					Future scenarios of Renal Replacement Therapy (RRT) in End Stage Renal Disease (ESRD) patients in Italy
F. Conte on the behalf of Italian Registry (RIDT) Committee
Background Other Syst ESK 6% 5% 20% ESRD patients admitted to a program of RRT Diab 16% are overall increasing in all western countries. Fig.4 PRD % % This grow is specially due to increasing in distribution GN acceptance rates of elderly patients and of 14% in incident HD 2002 patients Vasc those with co-morbid illness. In Italy from IN HN 22% 9% 8% RIDT data, in the last five years (1998-2002) Executive prevalence of patients on RRT changed from Primary renal diseases affecting incident Committee 786 to 898 pmp. Likewise incidence rate grow patients are shown in fig.4. Elderly patients are from 120 to 136 pmp. Patients undergone F. CONTE mostly affected by vascular diseases and dialysis treatment increased respectively from (Chairman) diabetes. Among diabetics 58% are over 65 yrs 620 to 693 pmp. As the incidence and while among affected by vascular PRD 75 % G. CAPPELLI prevalent rates have been increasing steadily are over 65. Applying increasing rate of 3%/yr to in the last five years, on the basis of F. CASINO age specific incidence rates to the predicted demographic projections referred to general general population we obtained an ESRD M. POSTORINO population and assuming that the increasing population structure for 2006 and 2010 as rate of new patients on RRT would maintain G. QUINTALIANI shown in tab. 2 stable, we have tried to design a picture of age 0-14 15-24 25-44 45-64 65-74 > 75 M. SALOMONE the possible future structure of demography 2002 0,9 1,5 10,2 30,8 29,6 26,9 of ESRD patients on RRT. Technical 2006 0,9 1,34 9,5 29,98 29,27 29,03 Methods Committee 2010 0,8 1,2 9 30,0 28,0 31,0 To perform this analysis we evaluated: Table 2: % distribution of incident patients according age and year A. DI NAPOLI i) demographic picture related to 2002, with projections to 2006 and 2010 adjusting Population structure A. LIMIDO data on the basis of the last population It seems clear that in 2006 and in 2010 the E. MANCINI census (2001) by the Italian Institute of higher proportion of new patient, respectively Statistics (ISTAT) 9183 and 10760, will belong to the class of M. NORDIO ii) epidemiological data coming from RIDT age over 75. Adjusting for population structure A. PINNA related to RRT in ESRD patients during the composition of expected incident patients 2002. will be as shown in the fig.5. A. ROSATI On this basis we made an estimation about Fig 5. D.SANTORO the need of RRT treatments for 2006 and Expected incident 2010 related to the population structure patients in 2006 , P. MESSA assuming an uniform increase of incidence 2010 (according increasing rates of rate of 3% per year as in the last years. 3%/yr, adjusted for Population structure of 2002, shows (fig.1) population composition a population of 56,993,742 From RIDT data in the last 5 years it was inhabitants with 18.7 % over 65 yrs. observed a stabilization in mortality rate (gross mortality mean value 13,5% ) with different Demographic projections for 2006 rates according to age. Applying to the Fig. 1 2002 population structure cumulative number of incident patients the age and 2010 (fig.2) are specific mortality rates the result at 2006 and respectively of 2010 would be a population quite different (fig.7) 57.382367 and from the expected one (fig.6) 57.623.250 with people over 65 of 20% and 20,8.%.
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National Committee S.Aloatti G. Bellinghieri A. Bonadonna M. Bonomini M. Brigante G. Cappelli F. Casino F. Conte S. Di Giulio B. Di Iorio A. Di Napoli G. Gaffi L. Gesualdo A. Pinna M. Postorino F. Quarello G. Quintaliani P. Riegler M. Salomone M. Salvadori A. Santoro

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Fig. 2 2010 population structure

Registry data concerning dialysis treatment on 2002 demonstrate ( Fig.3.) an incidence rate of 136 pmp and a prevalence rate of 693 pmp with different rates according age
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10 5 0 0-14 15-24 25-44 45-64 65-74 > =75

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Address for Correspondence: F. Conte Renal Unit “Uboldo “ Hospital Via Uboldo 12 IC-20063 Cernusco S/N – Milan-Italy E-mail: contefc@tin.it

Final Comments From the analysis of RIDT data it is possible to make some considerations: i) In absence of any intervention aimed to modify main causes of ESRD, and taking in account Incidence and prevalence rates ( pmp) (tab.1) ageing trends of general population we have to show higher levels in patients > 65 yrs expect constant increasing in RRT need. age 0-14 15-24 25-44 45-64 65-74 >75 ii) New patients will be older and affected with PRD like vascular diseases and diabetes, and will be Inc 9 18 45 167 391 439 more prone to suffer from more co-morbid factors Prev 13 59 239 927 2055 2062 and to present higher mortality rates. Table 1: 2002 incidence and prevalence rates (pmp) according age iii) Dialysis units will have to manage larger number of patients starting RRT, but also a grater number of 2002 prevalent patients were treated in hospital facilities for 75,6 % ( 54,9 public and patients leaving RRT, conditioning a high turn-over 20,7 profit), in limited care centers for 13,6%, and a high instability of prevalent patients. National for10,2% at home by PD and 0,6% by EC. In health care system in the next future will so have to face up with this increase of older patients , taking the same year 84 % of incident patients started RRT on EC , while 14 % on PD ( 2% up a lot of means, but owing to the reduced survival, also to high risk of drop out the RRT not defined)
0-14 -35 -30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30 35 F M

Fig. 3 2002 ESRD population structure (%)

Fig.6 New patients 2006/2010(%) Fig.7 Final population structure expected population composition 2006/2010 (%) after adjustment for specific death rates

D. Santoro A. Vasile


				
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