High incidence of renal failure requiring short-term dialysis: a prospective observational study.

BACKGROUND: Previous estimates of incidence of acute renal failure (ARF) requiring renal replacement therapy have varied from 18 to 75 patients per million per year, but have been beset by problems of definition. AIM: To investigate whether the '90-day rule' provides a more reliable, reproducible and robust estimate of the need for short-term dialysis. SETTING: District general hospital serving a population of 147 000. DESIGN: Prospective observational study. METHODS: Patients who received renal replacement therapy in Dumfries and Galloway between 01/01/94 and 31/12/2000 were divided into two groups: long-term dialysis (> or =90 days) and short-term dialysis (<90 days). RESULTS: Of 302 patients, 193 received short-term dialysis, giving an incidence for short-term dialysis of 187 patient episodes per million per year (95%CI 170-203). Use of a more conventional definition for ARF (including all ARF and acute-on-chronic renal failure, but excluding patients with chronic renal failure who present acutely) produced a similar estimate at 176 patients per million per year (95%CI 160-193). DISCUSSION: The 90-day rule estimated the incidence of short-term dialysis/ARF at nearly twice the incidence of chronic renal failure requiring dialysis, and more than twice the most recent estimate of the incidence of ARF in the UK. The main attraction of the 90-day rule is its simplicity. If the high level of short-term dialysis/ARF found in our study is confirmed by other centres, there are significant resource implications for the provision of renal care.

Haemodialysis in a rural area: a demanding form of treatment.

OBJECTIVE: To determine distances travelled and time spent waiting for transport among hospital haemodialysis patients living in a rural area. DESIGN: Cross sectional survey comparing the subregional dialysis unit in south west Scotland with 12 of the other 13 Scottish Adult Renal Units. SUBJECTS: Forty three Dumfries and Galloway patients and 935 other Scottish patients receiving hospital haemodialysis in November 1999. RESULTS: At the time of the survey 8/43 (19%) Dumfries patients travelled in excess of 100 miles per dialysis day (15,000 miles per year) solely for the purpose of dialysis, compared to 20/935 (2%) elsewhere in Scotland (p < 0.001). Twenty seven (63%) Dumfries and 594 (64%) patients in other Scottish Units relied on hospital car, Patient Transport Service bus or ambulance for the journey home after treatment. Dumfries patients who travelled by Patient Transport Service or hospital ambulance had to wait twice as long before they left the renal unit as patients using a dedicated hospital car or private car. CONCLUSION: Haemodialysis in a rural area has every reason to be considered a demanding form of treatment. Greater promotion of home based treatment would improve the quality of life for many of these patients, while dedicated hospital cars would reduce 'car to needle time' for those who remain on hospital haemodialysis.