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4.1 Pre-Dialysis - Retarding Progression and Reducing the Comorbid Burden in Renal Disease 4.1.3 Co-morbidity Burden in ESRF While most patients with renal failure have associated hypertension, about one third of patients are without any other discernible disease. In the remainder there is a spread of comorbidities, often florid, which may determine the rate of hospitalisation and survival on treatment. In a recent study of patients starting dialysis in a DGH, 38% had cardiovascular disease, 12% cerebrovascular disease, 24% peripheral vascular disease, 15% respiratory disease and 14% previous or current malignancy (ref.30). Death on RRT is overwhelmingly due to cardiovascular disease58. Contributing factors include previous undiagnosed hypertension and smoking which is unusually prevalent in the RRT population. In diabetic and non diabetic patients with renal diseases, smoking is associated with a higher incidence of progressive disease and in men, smoking has been observed to increase the risk of developing ESRF (ref.59,60). Hyperlipidaemia, a well-known risk factor for coronary artery disease also predicts progression in renal failure. There is evidence to suggest that in both diabetic and non-diabetic nephropathies, patients with elevated cholesterol and triglycerides progress more rapidly to renal failure (ref.61,62).  |