Treatment of end-stage renal failure due to diabetes in the United Kingdom, 1975-84

In 1975-84 762 new patients with end-stage renal failure (ESRF) due to diabetes mellitus were accepted onto renal replacement programmes in the United Kingdom. They formed 5.7% of the total intake of ESRF patients. This proportion rose from 1.4% in 1975 to 11.1% in 1984. 4.1% of the patients on renal replacement therapy at the end of 1984 were reported as having ESRF due to diabetic nephropathy. During 1983-84, 272 patients taken on were type I (76%) and 87 (24%) were type II diabetics. Continuous ambulatory peritoneal dialysis (CAPD) was most popular as both initial (51%, plus 24% on intermittent peritoneal dialysis in 1983-84) and long-term treatment (48% of 446 under treatment at Dec 31, 1984); 163 patients (36.5%) had successful allografts, and only 14% of patients were on haemodialysis. Actuarial survival was 49% at 3 years, irrespective of type of treatment; the death rate for type II diabetics approached the intake rate in 1983-84. There was considerable regional variation in the numbers of diabetics on treatment. Even though the proportion of diabetics entering British end-stage renal failure programmes is rising, many patients who may benefit from treatment are probably not receiving it.