What is the Difference between Causes of ESRD in Iran and Developing Countries?

Introduction: End stage renal disease (ESRD) is one of the most common life-threatening diseases. In the past two decades, there have been significant changes in the cause of ESRD around the world, and aim of the study was to determine its causes in Khouzestan province, Iran.

Materials and Methods: We retrospectively reviewed the medical records of our ESRD patients from January 1999 to March 2010. ESRD was defined as chronic and irreversible loss of kidney function requiring dialysis. We included only adult ESRD patients on maintenance hemodialysis, more than 2 months before entering the study. SPSS (version 15) software was used for data analysis.

Results: In our study, a total of 1000 adult ESRD patients, with mean age of 51.54 ± 16.39 years were included. The male to female ratio was 1.3: 1 which had no significant changes during the period of study. The mean age of our patients at starting of hemodialysis was 41.23 years in 1999, but it increased to 56.91 years in 2010, which is up 15.68 years during this period. In overall, the most common causes of ESRD were Diabetes Mellitus (n = 282, 28.2%), Hypertension (n = 265, 26.5%), unknown (n = 242, 24.2%), Glomerulonephritis (n = 79, 7.9%), Obstructive Uropathy (n = 70, 7%), Cystic Kidney Disease (n = 51, 5.1%) and unirenal (n = 1, 0.1%). Although, two main causes of ESRD in patients aged 40 years and older (n = 761) were also Diabetes Mellitus (n = 255, 33.5%) and Hypertension, however, in patients with less than 40 years of age (n = 239), the most common causes were unknown and Glomerulonephritis. There were no significant difference in the main causes of ESRD (Diabetes Mellitus and Hypertension) between men and women (P = 0.26 and P = 0.48). But there was a significant association between mean age of diabetic (56.71 ± 13.35) versus non diabetic (49.51 ± 17.03) hemodialysis patients (P < 0.001).

Conclusions: Based on our findings, the most common causes of ESRD in Khuzestan province, Iran were Diabetes Mellitus and Hypertension similar to developing countries. But, its causes are unknown in the significant percent of patients in contrast to these countries.