Trends of incident dialysis patients in Tunisia between 1992 and 2001.

Background: Reliable information about the burden of end-stage renal disease (ESRD) is still scarce in the developing world.

Study Design: Observational study of a national dialysis registry.

Setting & Participants: Patients incident to dialysis therapy captured in the Tunisian registry of renal replacement therapy (RRT).

Predictor: Intervals from 1992 to 2001.

Outcomes: Incidence rates of patients beginning dialysis therapy by age, sex, primary cause of ESRD, and region.

Results: The incidence of treated ESRD dramatically rose in Tunisia during the 10-year period to reach 158.8 cases/million people in 2000 to 2001. We hypothesize that the Tunisian population is experiencing better access to RRT, a decrease in mortality from other causes, and an increase in chronic kidney diseases from chronic disease causes. Chronic diseases that develop with aging and economic development prevailed in urban environments, with diabetic nephropathy rising at the rate of 16.1%/y, whereas renovascular diseases, which include hypertensive nephropathy, rose by 7.6% annually. Interestingly, tubulointerstitial nephropathies increased by 10.4% each year, which may be related to such environmental risk factors as dietary exposure to ochratoxin A, especially in rural settings. ESRD from unknown causes or with missing information about cause increased by 12.7% yearly. Large regional differences in total incidence persist despite constant efforts to level off inequalities in access to health care facilities and RRT treatment.

Limitations: Possible underreferral for RRT, underreporting of cases, and misdiagnosis.

Conclusions: The growing incidence of patients on dialysis therapy in Tunisia emphasizes that preventing chronic kidney disease and its progression should be a public health priority.