5.7.4. Risk factors

Hypertension and diabetes (Levin 2001), obesity (Ejerblad et al, 2006) and perhaps non-traditional risk factors such as anaemia, hyperphosphatemia, high plasma C Reactive Protein and Fibrinogen, high sympathetic activity and accumulation endogenous inhibitors of nitric oxide synthase (Zoccali 2006) appear to be the main drivers of CKD at population level. Patients with neoplasias and with chronic infectious diseases such as HIV and viral hepatitis (HBC) and patients exposed to nephrotoxic drugs are at higher risk for CKD.

There are no data on the relationship between socio-economic status and CKD. It is likely that these  links actually exist. Social inequalities affect the health of disadvantaged people for various reasons including access to education and health promotion initiatives and the psychosocial consequences of socio-economic inequalities. This is true for diseases such as hypertension (Diez Roux et al, 2002) and diabetes (Loucks et al, 2007; Seligman et al, 2007) in adults and obesity in children (Wang et al, 2006). Since these risk factors are also the main drivers of CKD, it appears likely that socioeconomic factors are also linked to CKD. According to data from the UK Renal Registry (UK Renal Registry, 2003), the prevalence of RRT was higher in socially deprived areas of the UK.

Currently, diabetes mellitus is the most common cause of RRT for ESRD, affecting more than 22% of the incident patients.

Apart from international differences in the incidence rates of RRT for diabetic ESRD and differences in stages of economic development across EU Member States, the causes for the considerable differences in the overall incidence rates of RRT between Member States are largely unknown. The incidence of RRT is the outcome of a complex interplay of many factors that have effects in different directions. The number of patients developing ESRD will, among other factors, be affected by the age and gender distribution in the general population, by the prevalence of underlying causes of ESRD, by the access to and quality of health care and by survival from so-called competing risks (e.g. cardiovascular mortality in the general population) (Jager and van Dijk, 2007). Another factor that must be considered is that once patients have developed ESRD, they may or may not be taken into RRT. There are no data available that support or refute the hypothesis of restriction of RRT, at least not in Western European countries.