ABSTRACT

Aim: To develop a renal registry that will monitor renal epidemiology in the Caribbean and help determine the burden of disease.

Methods: Questionnaires were sent out to different Caribbean countries for distribution to the dialysis units. Data were obtained for patients with End Stage Renal Disease (ESRD) who were on long term renal replacement therapy in 2006. The demographic data, type of renal replacement therapy, laboratory data and causes of ESRD were obtained from the questionnaire. Data were analyzed using SPSS 11.0

Results: Data were reported from six English-speaking Caribbean countries: Bahamas (n = 211), Barbados (n = 185), British Virgin Islands (n = 27), Cayman Islands (n = 41), Jamaica (n = 366) and Trinidad and Tobago (n = 436). Haemodialysis was reported in all the countries; transplantation was not reported from the Cayman Islands. Only Bahamas, Jamaica and Trinidad and Tobago reported peritoneal dialysis. In Jamaica, male to female ratio was 1.5:1. The three commonest causes of end stage renal failure were hypertension (65.5%), diabetes mellitus (27.6%) and primary chronic glomerulonephritis (12.5%). The age range was 11–94 years (mean 47.7 years). Barbados had a male to female ratio of 1.8:1, age range of 19–81 years (mean age: 52.3 years). Hypertension (55.7%) and diabetes mellitus (27.0%) were the commonest causes. Trinidad and Tobago had a male to female ratio 1.3:1. The age range was 8–84 years (mean age 52.5 years). The four commonest causes of ESRD were diabetes mellitus (28.9%), hypertension (25.3%) and autosomal dominant polycystic kidney disease (3.9%) and chronic glomerulonephritis (3.9%). The British Virgin Islands, Tortola, had a male to female ratio 1.7:1.0. Age range was 26–86 years (mean, 57 years). Hypertension (67.9%) and diabetes mellitus (46.4%) were also the commonest causes. The Bahamas had a male to female ratio of 1:1.1 unlike the other countries. Hypertension (25.6%), diabetes mellitus (28.0%) and chronic glomerulonephritis (13.3%) were the commonest causes of ESRD. The Cayman Islands reported a male to female ratio of 1.2:1, with a mean age of 54.3 years. Hypertension (n = 27), diabetes mellitus (n = 12) and autosomal dominant polycystic kidney disease (n = 3) were the commonest causes of ESRD. Barbados and Jamaica had more than 50 per cent of its renal replacement therapy patients with serum albumin above the minimum of the normal range of 35–40 g/L. In regards to the calcium phosphate product, two-thirds of the patients in all countries reporting data had values below the recommendation of 4.4 mmol2/L2. The percentage of patients achieving haemoglobin concentration above 10.0 g/dL was: 16.9% for Jamaica, 75.6% for The Cayman Islands, 35.9% for Barbados and 68.6% for Tobago. Erythropoietin usage was not reported. The URR was only available for Jamaica and the Bahamas and 80.6% and 60.9% respectively had URR above the accepted value of 65%. For all reporting countries the range of patients coded for hypertension but who also had diabetes mellitus was 2.2% to 17.1%. Only Bahamas reported on vascular access with 51.7% of patients having native arteriovenous fistulae.

Conclusion: Hypertension, diabetes mellitus and chronic glomerulonephritis were the commonest causes of ESRD across most of the English-speaking Caribbean countries. Peritoneal dialysis was only offered in some of the islands and kidney transplantation was rarely reported. More males than females were on long term renal replacement therapy in most of the islands.