THE EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE IN VOLOGDA OBLAST

THE AIM of the work was to study the epidemiologgy of chronic kidney disease (CKD) in Vologda oblast of the Russian Federation. PATIENTS AND METHODS. A population retrospective investigation performed in the Vologda oblast during the period from 1.07.98 till 30.06.99 has revealed cases of chronic renal failure (CRF) with blood serum creatinin Cr і 300 mkmol/l that corresponds to the IV and V stages of CKD by the calculated values of the glomerular filtration rate. The incidence and morbidity of the IVV stage CKD were determined including those depending on the gender, age, cumulative survival of patients with different etiology of CKD depending on using the substitution renal therapy (SRT) and the nephrologist’s supervision. RESULTS. The examinations have revealed 370 patients with CKD of the IVV stages. The average incidence and mobidity was 286 patients per million (PPM) and 135 p/m, in some cities it was 372434 PPM and 175260 PPM. The men/women ratio was the same (1.03). The most frequent cause of the development of CKD was chronic glomerulonephritis (CGN) 41%, the share of chronic interstitial nephritis was 16%, of diabetes mellitus (DM) 14%, polycystic kidney 8%, amyloidosis 6%, hypertensive nephrosclerosis 2%, other causes 3%, cases with not quite exact etiology 10%. The structure of primary renal pathology in patients given SRT was a little different: the share of patients with CGN increased to 61%, and the share of patients with DM and amyloidosis sharply decreased to 1.6% and 0,8%. The patients (31.1%) not given SRT had Cr > 500 mkmol/l and GFR < 10 ml/min. The incidence of cases of IVV stage CKD where the patients received SRT was 80 PPM, while the number of patients who first started SRT during 1 year, was 8 PPM. Mortality among the patients with renal failure was 85 PPM/ year. Increasing uremia was the cause of death of 88.4% of all the dead not given SRT. The cumulative survival among the patients receiving SRT was 90%, among those not receiving SRT was 50% for a year. Survival of patients with CKD not receiving SRT and observed by a nephrologist was reliably higher (p=0.003). CONCLUSION. The frequency of new cases of CKD of the IVV stages in the region under study is comparable with similar indices in Europe while the incidence was substantially lower due to a less share of people of older age groups and patients receiving SRT. The solution of this urgent problem of treatment of CKD patients in regions of Russia requires both an improvement of the neurological service as a whole and the development of the program of SRT covering now as little as the tenth part of the current requirements.

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