Chronic renal failure in primary care

Overview

The prevalence of patients with chronic renal failure treated by one method of renal function replacement is steadily rising. Nowadays, the most frequent cause of renal failure is diabetic nephropathy and nephrosclerosis. Haemodialysis treatment is very expensive, in general the treatment of 0.1–0.2% of the population consumes 4–7% of the total health care expenditure. In comparison with non-dialyzed renal failure patients, the quality of life of dialyzed patients is substantially lower. Mortality of patients with end-stage renal disease treated by haemodialysis remains very high: 20–25% per year. The yearly mortality of patients after successful kidney transplantation is markedly lower than in haemodialyzed patients (cca 10 times), however their mortality remains significantly higher than in the age-matched population.

At present we have scarce information about mortality and risk of development of a haemodialysis requiring end-stage renal disease in a homogenous unselected population of patients with advanced renal failure. Data available refer to patients from randomized clinical trials which represent a selected population with a probably lower incidence of co-morbidities than usual, and thus with a better prognosis. A conservative treatment aims to control metabolic disturbances associated with an impaired renal function, and to postpone commencement of haemodialysis treatment in certain cases.

Key words:
renal failure, end-stage renal disease, therapeutic modalities