On the impact of and need for chronic dialysis and renal transplantation.

The acceptance rate onto chronic dialysis is increasing linearly, but when expressed as a percentage of those in need the steepest increase occurred in the mid- and late 1970s; this increase is much slower now because the population dying of end-stage renal disease (ESRD) seems to be increasing as well. The increase in ESRD between 1960 and 1981 was 67%. Of this increase, 30% resulted from an increase in the population and 37% from an apparent increase in the incidence of ESRD. Transplant rate, as a percentage of patients accepted onto dialysis, has decreased because the number of patients on dialysis is increasing faster than available transplant kidney grafts. Almost all patients who are currently not accepted are older than the age of 60, and if they are accepted they will have a much shorter survival time than the present dialysis patient population. Although acceptance rate, as incidence per year, will probably continue to increase significantly, the prevalence figures of patients on chronic dialysis will probably increase less fast, as the patients will have shorter survival times. This overall shortening of survival time will probably be further shortened as transplanters increasingly transplant the younger patients who would have the longest survival times on dialysis.