Demography and management of childhood established renal failure in the UK (Chapter 13)

The incidence and prevalence of ERF in children in the UK are relatively static at 8.0 and 47.7 per million population under the age of 15 years, respectively. The prevalence of ERF in children from the South Asian community is almost three times that of the White population whilst the incidence is over three times that of the White population and similar to the increase seen in the adult population. The high incidence and prevalence are related to the high incidence of inherited diseases which cause ERF in the South Asian community. ERF in children is more common in males than females (male to female ratio 1.54:1). This is due to a preponderance of males with renal dysplasia and obstructive uropathy causing ERF. For the South Asian patients, the gender ratio is 1:1 as the inherited diseases are mainly autosomal recessive. Renal dysplasia is the single most common cause of ERF in childhood, followed closely by glomerular disorders and then obstructive uropathy. The majority of prevalent paediatric ERF patients (76%) have a renal allograft. Of these, 28% are from living donations. The proportion of patients from ethnic minority groups with a functioning allograft is significantly smaller than that in the White population (P < 0.0001). Despite this, the rate of living related donation is no higher in the ethnic minority population. In prevalent patients PD is twice as commonly used as HD with the majority managed with automated PD. For patients at one year from starting RRT, 49% are on PD, 10% on HD and 41% have a transplant.