Transcript Reduced Incidence of ESRD in Denmark since 2000

Reduced Incidence of ESRD among
60 to 80–year-olds in Denmark
Heaf JG1, Wehberg S2, Engberg H2
Danish Nephrology Registry
1Herlev Hospital, University of Copenhagen;
2Hvad hedder competencecenter syd på engelsk
Methods
• Results of the Danish Nephrology Registry
(DNR) 1990-2010 (population 5.5 million)
• National registry, comprehensive since 1990
• >99% Data completeness
• Incidence of actively treated ESRD since 1990,
analysed according to age and diagnosis
• National antihypertensive prescription rates
since 1995 from Danish Medicines Agency
Results (1)
• Stable incidence for ages 0-60 years
• Rising incidence rates during the 1990s for
elderly cohorts
– 60-70 years 262 (1990) → 400 (2001) ppm/yr
– 70-80 years 106 (1990) → 593 (2002) ppm/yr
– >80 years
5 (1990) → 557 (2007) ppm/yr
• National hypertensive prescription rates have
tripled between the years 1995 and 2010
Results (2)
• Falling incidence rates for cohorts 60-70 and
70-80 years since 2001
– 60-70 years 400 (2001) → 256 (2010) ppm
– 70-80 years 592 (2002) → 401 (2010) ppm
– >80 years 556 (2007) → 421 (2010) ppm
• Falling incidence distributed between a range
of different diagnoses
ESRD Incidence and Age
Alder: 20- år
30
20
10
1994
1998
2002
2006
100
50
0
150
100
50
Antal per ppm*
200
10
2010
1990
1994
0
0
400
200
2006
2010
Alder: 50- år
200
150
100
50
1990 1994 1998 2002 2006 2010
Alder: 70- år
600
2002
0
0
1990 1994 1998 2002 2006 2010
1998
1990 1994 1998 2002 2006 2010
Alder: 60- år
400
20
Alder: 40- år
200
1990 1994 1998 2002 2006 2010
600
30
Antal per ppm*
150
Antal per ppm*
Antal per ppm*
Alder: 30- år
200
40
Antal per ppm*
40
1990
Antal per ppm*
50
Antal per ppm*
Antal per ppm*
Alder: 0- år
50
Alder: 80 + år
600
400
200
0
1990 1994 1998 2002 2006 2010
1990 1994 1998 2002 2006 2010
150
100
ESRD Incidence age 60-70 years
0
50
0
1990 1994 1998 2002 2006 2010
1990 1994 1998 2002 2006
600
400
200
Antal per ppm*
Antal per ppm*
Alder: 60- år
0
Alder: 70- år
600
400
200
Antal per ppm*
50
Antal per pp
100
Antal per pp
Antal per pp
150
0
1990 1994 1998 2002 2006 2010
1990 1994 1998 2002 2006
Hypertensive Prescription 1995-2010
Incidence 2000-01 & 2009-10
Age 60-70 years
Incidence 2000-01 & 2009-10
Age 70-80 years
Change in Incidence 2000-1 to
2009-10
Age
(years)
Discussion (1)
• The rise in ESRD incidence during the 90s is
probably due to increased take-on rates as a
result of reports showing satisfactory results
for active treatment of elderly patients with
high comorbidity (e.g. DM). There is no
evidence to suggest that physicians’
willingness to offer active therapy has fallen
since 2000.
Discussion (2)
• The fall in incidence since 2000 for patients aged 60-80 years is
significant and major. Antihypertensive therapy, in particular ACE
inhibitors and angiotensin receptor blockers (ARBs) have been
shown to delay the progression of uraemia in patients with chronic
nephropathy, and in particular diabetic nephropathy. The use of
antihypertensive therapy has increased rapidly in Denmark since
1995. It is therefore possible that the observed fall in incidence is a
consequence of increased focus on uraemia prophylaxis using
antihypertensives and other drugs.
• The increase in take-on rates for 80-year-olds is a more recent
phenomenon. It is thus not possible at present to determine what
effect therapeutic intervention has had on ESRD incidence in this
age group. It is even possible that the increased rate in this group is
partly a result of therapeutic intervention, by postponing ESRD in
the 60-80-year-olds to this age group.
Economic Consequences
• Assumptions for calculation
– The reduced incidence for patients 60-80 years since 2001 is real and
causal
– Without intervention the ESRD rate would be 400 ppm for patients
aged 60-70 and 593 for patients aged 70-80
– Median ESRD survival 4.3 and 2.5 years for 60-70 and 70-80-year-olds
(DNR data 2005-2010)
– ESRD costs €50,000/year
– Population age distribution as in Denmark
• Consequences
– ESRD incidence has been reduced by 30.6 ppm/yr
– ESRD prevalence has been reduced by 108 ppm
– ESRD expenditure has been reduced by ca. €5 per head of
population/year