Epidemic of kidney disease

By REBECCA WALSH health reporter

New Zealand is at the start of an epidemic that will see increasing numbers of elderly Pakeha needing life-saving kidney dialysis treatment, a renal physician has warned.

Dr Krishan Madhan, director of renal services at Taranaki Base Hospital, said the epidemic was second, "if not equal", to the epidemic of diabetic renal disease and would put increasing pressure on stretched services.

In a paper published in the New Zealand Medical Journal, Dr Madhan said a review of data held by the Australia and New Zealand Dialysis and Transplant Registry showed the number of patients aged over 65 on dialysis went from 28 in 1991 to 139 in 2001.

"This is an increase of 396 per cent compared to a growth of 170 per cent for those aged less than 65 years."

That trend would continue as the number of elderly people in the population grew - Census data indicated the number aged 65 and over would double to 1.18 million by 2051.

Dr Madhan said as people aged "the more things go wrong with you". Vascular disease, in particular high blood pressure, was the main reason older people suffered end-stage renal failure as opposed to diabetes in the younger age group.

In 2001, two-thirds of those over 65 who had dialysis were Pakeha, 19 per cent Maori, 9 per cent Pacific Islanders and others 6 per cent.

In contrast, Pakeha made up 46 per cent of all dialysis patients, Maori 32 per cent, Pacific Islanders 15 per cent and others 7 per cent.

Dr Sharad Ratanjee, a consultant at Middlemore Hospital's renal unit, said staff had noticed an increase in the number of older people on dialysis - almost half the new dialysis patients now were over 65.

In February, the Herald reported ballooning demand for kidney dialysis in South Auckland, largely due to the high incidence of diabetes.

Dr Ratanjee said space was tight and the hospital would run out of room by the end of the year. Additional night shifts were possible but new facilities would be needed.

Dr Madhan said that while diabetes would "outgrow everything else" - about 25 per cent of those over 65 had diabetes related, end-stage renal failure - it was important not to forget the other factors that contributed to the problem.

Discussion was needed on how health services would cope with the influx of patients and what could be done to prevent it.

At the same time, any debate was likely to raise philosophical questions about whether helping people to live longer simply "pushes out the time the disease occurs".

Dr Madhan said there was no cut-off age for dialysis in New Zealand. Patients discussed the pros and cons of treatment with their specialist.

"Someone may say 'I'm 70 years old, I've had a good run. I don't want to do anything.' On the other hand, I might have another 80-year-old who is so full of life this is just another hurdle."