RENAL CARE More than 4 per cent of the Swedish population has significantly impaired renal function. Most of them do not face any immediate danger, but the condition is associated with increased risk of cardiovascular disease or death. Only a small percentage of people develop renal failure so serious that lifesaving dialysis or transplant (renal replacement therapy) is needed. More than one third of all patients who need dialysis or transplant have diabetes. Other common (15-20 per cent) indications for renal replacement therapy are atherosclerosis of the kidney and chronic glomerulonephritis, which affects a considerably more heterogeneous patient population. Hereditary kidney disease accounts for approximately 10 per cent. Approximately 1 100 patients have started treatment every year for the past decade. The total number of patients who had been treated for life-threatening renal failure had risen by approximately 3 per cent annually over the past ten years to 8 752 at the end of 2011. A gradual improvement in survival is the reason for the increase. With respect to both new and existing patients, Sweden is in the average range for Western and Northern Europe. Life-threatening kidney disease is twice as common in men as women. Approximately one-half of all patients in renal replacement therapy have a functioning transplant and half are being given dialysis. Sweden has a high percentage of transplants, surpassed only by Norway among neighbouring countries. Approximately three-quarters of dialysis patients receive haemodialysis and the remainder receive peritoneal dialysis. Depending on what is included in the calculation, the total annual cost of Swedish dialysis and transplant care is an estimated SEK 2-3 billion. These patients would die if they were not treated. Due to its high health-related and patient-reported quality of life and low mortality risk, kidney transplant is the better option. For medical reasons, transplant is appropriate for only one-quarter of all new patients. Because of the shortage of organs from deceased donors, most candidates must undergo dialysis for an average of 2-3 years before transplant. Patients who have access to a living donor can receive a transplant just before dialysis is needed or a short time thereafter. Thus, available, high-quality dialysis is both a life-sustaining measure for patients who cannot receive transplants and a necessity if transplant services are to work properly. This report presents four indicators, each based on data from the Swedish Renal Registry, to which all clinics report. The register, which includes every transplant patient and at least 95 per cent of chronic dialysis patients, collaborates with the Swedish National Board of Health and Welfare on comparisons of participation rate.
QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012
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