End-stage renal disease in Michigan. Incidence, underlying causes, prevalence, and modalities of treatment.

In Michigan from 1974 through 1981 the average annual end-stage renal disease (ESRD) incidence was 7.76 for males and 5.55 for females per 100,000 population. Those over 35 years of age had higher incidence rates. The average incidence for black ESRD patients was 20.75, compared with 4.78 for white ESRD patients. Thus, the risk of ESRD was 4.34 times higher in the black population. In 1981, the stated causes of ESRD in the ESRD population were diabetes mellitus (24.5%), hypertension (24.2%), and glomerulonephritis (20.9%). Black ESRD patients, compared to white, had relative risks of 3.8 for diabetes mellitus, 10.9 for hypertension, and 1.7 for glomerulonephritis. The ESRD point prevalence increased from 11.58 in 1974 to 31.68 in 1981. Males predominated over females; the sex-specific ESRD prevalence in 1981 being 36.74 and 26.83, respectively. Blacks predominated over whites; the black and white ESRD prevalences in 1981 were 80.27 and 24.81, respectively. Prevalence over these years increased faster for older age groups. Hemodialysis at a center has been the major ESRD treatment modality. The percentage of all ESRD patients on home hemodialysis steadily decreased from 1974 through 1981. Similarly, on a percentage basis, fewer patients were transplanted in 1981 than in 1974. The number of ESRD patients treated by chronic ambulatory peritoneal dialysis increased more than sevenfold from 1979 through 1981.