1. Reduced Incidence of ESRD among 60 to 80–year-olds in Denmark Heaf JG 1, Wehberg S 2, Engberg H 2 Danish Nephrology Registry 1 Herlev Hospital, University of Copenhagen; 2 Hvad hedder competencecenter syd på engelsk

2. Methods Results of the Danish Nephrology Registry (DNR) 1990-2010 (population 5.5 million) National registry, comprehensive since 1990 >99% Data completeness Incidence of actively treated ESRD since 1990, analysed according to age and diagnosis National antihypertensive prescription rates since 1995 from Danish Medicines Agency

3. Results (1) Stable incidence for ages 0-60 years Rising incidence rates during the 1990s for elderly cohorts – 60-70 years262 (1990) → 400 (2001) ppm/yr – 70-80 years 106 (1990) → 593 (2002) ppm/yr – >80 years 5 (1990) → 557 (2007) ppm/yr National hypertensive prescription rates have tripled between the years 1995 and 2010

4. Results (2) Falling incidence rates for cohorts 60-70 and 70-80 years since 2001 – 60-70 years 400 (2001) → 256 (2010) ppm – 70-80 years 592 (2002) → 401 (2010) ppm – >80 years 556 (2007) → 421 (2010) ppm Falling incidence distributed between a range of different diagnoses

5. ESRD Incidence and Age

6. ESRD Incidence age 60-70 years

7. Hypertensive Prescription 1995-2010

8. Incidence 2000-01 & 2009-10 Age 60-70 years

9. Incidence 2000-01 & 2009-10 Age 70-80 years

10. Change in Incidence 2000-1 to 2009-10 Age (years)

11. Discussion (1) The rise in ESRD incidence during the 90s is probably due to increased take-on rates as a result of reports showing satisfactory results for active treatment of elderly patients with high comorbidity (e.g. DM). There is no evidence to suggest that physicians’ willingness to offer active therapy has fallen since 2000.

12. Discussion (2) The fall in incidence since 2000 for patients aged 60-80 years is significant and major. Antihypertensive therapy, in particular ACE inhibitors and angiotensin receptor blockers (ARBs) have been shown to delay the progression of uraemia in patients with chronic nephropathy, and in particular diabetic nephropathy. The use of antihypertensive therapy has increased rapidly in Denmark since 1995. It is therefore possible that the observed fall in incidence is a consequence of increased focus on uraemia prophylaxis using antihypertensives and other drugs. The increase in take-on rates for 80-year-olds is a more recent phenomenon. It is thus not possible at present to determine what effect therapeutic intervention has had on ESRD incidence in this age group. It is even possible that the increased rate in this group is partly a result of therapeutic intervention, by postponing ESRD in the 60-80-year-olds to this age group.

13. Economic Consequences Assumptions for calculation – The reduced incidence for patients 60-80 years since 2001 is real and causal – Without intervention the ESRD rate would be 400 ppm for patients aged 60-70 and 593 for patients aged 70-80 – Median ESRD survival 4.3 and 2.5 years for 60-70 and 70-80-year-olds (DNR data 2005-2010) – ESRD costs €50,000/year – Population age distribution as in Denmark Consequences – ESRD incidence has been reduced by 30.6 ppm/yr – ESRD prevalence has been reduced by 108 ppm – ESRD expenditure has been reduced by ca. €5 per head of population/year