END-STAGE RENAL-DISEASE AND RENAL REPLACEMENT THERAPY IN KUWAIT - EPIDEMIOLOGIC PROFILE OVER THE PAST 4 1/2 YEARS

Data on end-stage renal disease (ESRD) patients in Kuwait were collected retrospectively and prospectively starting in mid-1988. The study period covered 4 1/2 years from 1 January 1986 to 30 June 1990. Epidemiological characteristics of ESRD patients and their disposal by dialysis and transplantation were analysed and compared with previous reports from Kuwait, neighbouring countries, Europe, and USA. A total of 647 patients received renal replacement therapy (RRT) in Kuwait during the study period. This gave an incidence rate of 72 patients per year per million of population. The prevalence rate for patients on maintenance dialysis was 80.6 per million population in mid-1988. Nearly one-fifth of total patients (19.6%) were older than 60 years of age and one-third (30.8%) were identified as 'high risk' category. As for Kuwaiti nationals alone on RRT 29.70/o were above 60 years of age and 44.2% were high-risk patients. We have noticed a steady decline in the number of patients who accepted continuous ambulatory peritonial dialysis (CAPD) for dialytic support. Chronic tubulointerstitial disease resulting from atrophic pyelonephritis was the leading cause of ESRD amongst both Kuwaiti nationals and expatriates. Though diabetic nephropathy was only the third leading cause of ESRD (14.7%) in the total population, it was more frequent (21.2%) among Kuwaitis. The gross mortality rate on dialysis was 14.7%. The major causes of death were related to cardiovascular diseases (60%) and sepsis (24.2%). Our analysis showed that age of the patient at admission to dialysis contributed to overall mortality, but it was not an isolated risk factor whereas diabetic nephropathy (relative risk 1.9) and associated serious co-morbid illness/es (relative risk 30.3) were. Despite strict precautionary measures in the dialysis units and early use of erythropoietin, 68 new patients were detected to be HBsAg positive, 85% of whom remained persistently antigenaemic for more than 6 months. At follow-up 9.8% (4/41) had died of liver failure. The 50 months patient survival for patients who received unrelated kidney transplantation (abroad) was lower than in those who received live related kidneys in Kuwait. The most distressing observation was, however, the very high patient loss associated with imported cadaver kidneys transplanted in Kuwait compared to those who received cadaver kidneys harvested locally (65% versus 94.8% respectively at 16 months).