The provision of renal replacement therapy for adults in England and Wales: recent trends and future directions

We assessed the level of provision of renal replacement therapy for adultsin England and Wales. All autonomous main renal units in England (n = 52)and Wales (n = 5) were surveyed in 1996. Data for England were compared tothe 1993 National Renal Review. The acceptance rate in England 1995 was 82(80-85) per million population (p.m.p.) compared with 67 (65-70) p.m.p. in1991-2. The rate in 1995 in Wales was 109 (98- 122) p.m.p. The prevalencerate in England was 476 p.m.p. at end-1995 compared to 393 p.m.p. in 1993,in Wales it was 487 p.m.p. The number of main renal units in England didnot rise between 1993 and 1995; capacity was increased by use of moretreatment shifts and temporary haemodialysis stations, and by opening moresatellite units. The main growth was in hospital haemodialysis. There wasan uneven geographical distribution of services. Patients accepted wereolder with more comorbidity. The use of better-quality processes ofdialysis increased. The steady-state position for RRT will not be reachedfor over a decade. Health authorities will face continued pressure to fundincreases in quantity and quality improvements. A stronger evidence base ofthe effectiveness of therapies, and a national registry to monitor theequity and cost-effectiveness of services are needed.