The need for renal replacement therapy in Scotland.

Each year 80-100 people per million of the population develop end stage renal failure and are medically suitable for renal replacement therapy. This need has been met in Scotland in each of the last three years. With current knowledge there is no prospect of measures to prevent renal disease affecting this number in the foreseeable future. The number of patients on renal replacement therapy in Scotland will increase over the next 15 years to approximately 160% of the current number. The mean age of patient on replacement therapy will increase progressively over the next 15 years. The increase in numbers will be in patients receiving 'in centre' haemodialysis and in those with functioning renal transplants. To meet this increase an approximately 3-4 increase in the current 'in centre' haemodialysis facilities will be required. Additional haemodialysis centres should be established to reduce the time spent by patients travelling for treatment and to avoid centres becoming 'impersonal' by becoming too large. Moves to increase the transplantation rate should be encouraged as transplantation offers the best quality of life for patients. Research should be directed towards improving long term graft survival.