The need and demand for renal replacement therapy in ethnic minorities in England.

Abstract

Study objective -The study aimed to determine the relative risk of being accepted for renal replacement treatment of black and Asian populations compared with whites in relation to age, sex, and underlying cause. The implications for population need for renal replacement therapy in these populations and for the development of renal services were also considered. crude relative acceptance rates compared with whites were 3 5 and 3-2 respectively. Age sex specific relative acceptance ratios increased with age in both ethnic populations and were greater in females. Age standardised acceptance ratios were increased 4-2 and 3-7 times in Asian and black people respectively. The most common underlaying cause in both these populations was diabetes; relative rates of acceptance for diabetic end-stage renal failure were 5 8 and 6 5 respectively. The European Dialysis and Transplant Association coding system was inaccurate for disaggregating non-insulin and insulin dependent forms. "Unknown causes" were an important category in Asians with a relative acceptance ofrate 5 7. The relative rates were reduced only slightly when the comparison was confined to the district health authorities with large ethnic minority populations, suggesting that geographical access was not a major factor in the high rates for ethnic minorities. Conclusion -Acceptance rates for renal replacement treatment are increased significantly in Asian and black populations. Although data inaccuracies and access factors may contribute to these findings, the main reason is probably the higher incidence of end-stage renal failure. This in turn is due to the greater prevalence of underlying diseases such as non-insulin dependent diabetes but possibly also increased susceptibility of developing nethropathy. The main implication is that these populations age demand for renal replacement treatment will increase. This will have an impact nationally but will be particularly apparent in areas with large ethnic minority populations. Future planning must take these factors into account and should include strategies for preventing chronic renal failure, especially that due to non-insulin dependent diabetes and hypertension. The data could not determine the extent to which population need was being met; further studies are required to estimate the incidence of endstage renal failue in ethnic minority populations. (J7 Epidemiol Community Health 1996;50:334-339) Although end-stage renal failure is relatively uncommon, treatment by renal replacement therapy (dialysis or transplantation) is complex, costly, and has to be given lifelong. Without treatment patients die. Provision in the UK has expanded significantly in the past decade. We present data from the national review of renal services in England, the first time a national dataset on ethnicity and uptake of health 334 on 29 April 2019 by guest. Protected by copyright.

Microalbuminuria and Coronary Heart Disease Risk in an Ethnically Diverse UK Population

“…However, in the United Kingdom, in those with diabetes, South Asians are known to have a 13-fold increase in risk for ESRD compared with Europeans (30), and in those without diabetes, South Asians have a 3.5-fold increase in risk (28,30,31). A large US primary care study of people with diabetes found that those of Asian origin without hypertension had two-fold prevalence of microalbuminuria (32).…”

Ethnicity, Socioeconomic Status, and Attainment of Clinical Practice Guideline Standards in Dialysis Patients in the United Kingdom

“…For patients with missing ethnicity data on the UKRR database, ethnicity was updated in a hierarchical order: from the UK Transplant database, the independent organization responsible for maintaining the national organ donor register in the UK, using the name-recognition software program SANGRA, developed and validated in the UK to identify South Asian ethnic origin by name (20); and finally by recoding patients with missing ethnicity as Whites if they lived in a UK Census 2001 ward that had a predominant White population (Ͼ98%). The incidence of RRT is three to four times higher in ethnic minorities compared with Whites in the UK (21,22), and therefore updating ethnicity using Census statistics could potentially lead to a misclassification error of up to 6% to 8%, which was considered acceptable. Patients whose ethnicity could not be updated by the above methods and those with missing primary renal disease and residence postcode were excluded from the study.…”

Ethnicity and renal disease: questions and challenges

“…2,4 Data from the Thames region in the early 1990s confirmed that the non-diabetic South Asian population had an age-adjusted relative risk of developing ESRD of 3.5 compared to the white European population, and the African Caribbean population had an increased risk of 3.2. 5 In the African Caribbean population, hypertension and type 2 diabetes are the dominant causes of ESRD, with an additional important influence of sickle cell disease. In South Asians, not only are there significant increases in diabetic nephropathy, but also of most types of glomerulonephritis (confirmed by renal biopsy) as well as reflux nephropathy.…”