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The evolution of the end-stage renal disease program in Australia.

Australia was an early pioneer of national integrated programs for the management of end-stage renal disease (ESRD). From being a leader in numbers of patients per population treated, it is now in the top 15. The Australian program has a high proportion of living patients with functioning transplants and a high proportion of out-of-hospital dialysis. The proportion of elderly patients is increasing but lower than expected. A particular problem is the treatment of Aboriginal people. The ANZ Data surveys give accurate complete data for the national program. Unique features of the Australian patients are the high incidence of analgesic nephropathy and the low incidence of primary hypertension as a cause of renal failure. Surveys show that it is possible to improve transplantation rates 2 to 3 times. Analysis of Australian data raises the question of whether dialysis and transplantation should be offered to all potential patients regardless of comorbidity or quality of life when health resources are inevitably finite.