Geographical variation in the referral of patients with chronic end stage renal failure for renal replacement therapy

The number of dialysis units per million population is low in the UK by comparison with other European countries, and this may affect the referral of patients for renal replacement therapy. We used a Poisson regression model to analyse the spatial distribution of all 539 adult patients resident in south-west Wales (Dyfed and West Glamorgan) who started chronic renal replacement therapy between April 1985 and March 1994. Controlling for patient age, population distribution, socio-economic variables and ethnic group, there was a significant negative relationship between referral rates and distance of residence from the renal unit for patients aged over 60 years, but not for younger patients. The prevalence of renal replacement therapy rose from 128 to 454 per million in Dyfed, and from 188 to 647 per million in West Glamorgan, between 1985 and 1995.