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A new End-Stage Renal Disease Medical Evidence Form (2728) was introduced on April 1st, 1995 and included new categories for renal diagnosis, race, ethnicity, employment status, and insurance type, along with new mandatory fields for biochemical data. To determine demographic and bio-chemical trends, as well as the completeness of each record, we constructed data sets for 1995 and 1996 incidence patients, using information from the biochemical and demographic fields contained on the form. In order to assure that this information came from the new 2728 form we selected only those patients who had the mandatory bio-chemical BUN field completed, 44,346 and 56,117 for 1995 and 1996 respectively.
We have provided incident patient rates for age, gender, race, modality, and primary diagnosis within major groupings which include renal network, age and gender, race and gender, and modality. Mean height, weight, hematocrit, hemoglobin, albumin, creatinine, creatinine clearance, BUN, Urea clearance, types of medical coverage at initiation, comorbidity at initiation, and employment status at initiation are also provided.
Also provided are thematic maps which depict comorbid conditions such as congestive heart failure, peripheral vascular disease, myocardial infarction, ischemic heart disease, cerebral vascular accident, as well as albumin levels, patients who received EPO prior to dialysis, incidence of smoking, mean ESRD Time and change in prior ESRD time from 1987-1996.
Our data show that in 1996, within all renal networks, new patients tended to be 45 years and older, there were more males than females, and the majority of patients were white (57%). Eighty-six percent of new patients initiated on hemodialysis, and diabetes and hypertension were the chief causes of renal failure.
Completeness of biochemical data fields varied ranging from 100% completion for BUN to a low of 2.8% for the Urea Clearance. Hematocrit and hemoglobin fields had a completion rate of 97% and 90%, respectively, while albumin values were filled in 84% of the time.
Our data show that 34% of new patients aged 0-19 years initiated dialysis on CCPD, and that the rate of diabetes as a primary diagnosis was much lower for this group compared to all other age groups. Hematocrit levels of less than 30% were evident in more than 60% of all new patients, while only 24% received EPO pre-dialysis. The mean hematocrit for all new patients was 27.3%. Approximately 52% of all new patients had pre-dialysis albumins of < 3.5 mg/dl; this rate reached 65% in the Native American population. The mean albumin for all patients was 3.3 mg/dl. Pre-dialysis BUN was 94 mg/dl, and the mean serum creatinine was 8.4 mg/dl.
The most evident comorbid conditions in new patients were hypertension (72%), followed by diabetes primary and diabetes insulin (64 %), congestive heart failure (35%), and ischemic heart disease (25%).
Our mapping data show that nationwide, congestive heart failure appears to be the most evident comorbid cardiac condition, approximately 60% of new patients initiate dialysis with a serum albumin below 3.5 mg/dl, the majority of new patients are non-smokers, and the mean prior ESRD time has increased during the period 1987-1996 indicating longer survival periods for patients.
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