Section 10: Renal Diseases
10.2 End Stage Renal Disease Prevalence
The annual prevalence of End Stage Renal Disease (ESRD) in the United States is 361,031 (based on 1997 data, United States Renal Data Systems [USRDS] 1999 Renal Data Report). The prevalence rates for ESRD have increased substantially (e.g., from 219,255 in 1991, to 314,364 in 1995, to 361,031 in 1997), most likely because of improved survival rates among high-risk populations (e.g., patients with diabetes, hypertension), improvements in management of ESED, and the aging of the population. In general, ESRD is the result of three primary diseases: diabetes, hypertension, and glomerulonephritis.
End Stage Renal Disease and Driving Literature Review
To this author's knowledge, there are no studies that have investigated the relationship between chronicrenal failure and risk of motor vehicle crashes. There is a small body of literature, however, indicating that ESRD is associated with diminished perceptual motor-coordination, impairments in intellectual functioning including decreased attention and concentration, and memory impairments (Baker, Brown, Byrne, et al., 1989; Ginn, Tescahn, Walker, et al., 1975; Hart, Pederson, Czerubski, and Adams 1983; Hagberg, 1974; McGee, Burnett, Raft, Batten, and Bain, 1982; Ryan, Souheaver, and DeWolfe, 1980; but see Kramer, Madl, Stockenhuber et al., 1996; Pliskin, Yurk, Ho, and Umans, 1996; Umans and Pliskin, 1998). It is interesting to note that the earlier studies are more likely to report the presence of cognitive impairment in individuals with ESRD compared to more recent studies. It may be that more effective management of ESRD in the last decade or so has led to substantial improvements in cognitive functioning in this patient population.
There is some suggestion that the effects of ESRD on cognitive functioning may differ as a function of type of dialysis program the patient is on. For example, Buoncristiani, Gubbiotti, Mazzotta, et al. (1993) investigated the relationship between cognitive functioning in patients undergoing either peritoneal or hemodialysis and healthy controls. The sample included 18 patients on continuous ambulatory peritoneal dialysis (CAPD), 15 on hemodialysis comparable in terms of age and time on dialysis, and normal controls. P300 event related potentials were used as an objective marker of cognitive brain function. Results showed that the latencies of the P300 in CAPD patients were comparable to normal controls and to those obtained in postdialytic patients on hemodialysis. However, the results of the predialytic values were significantly different from the postdialytic values, and from the values of the CAPD patients and controls. These results suggest that hemodialysis may restore the cognitive functioning of patients only transiently in the postdialytic stage. On the other hand, results of this research suggest that cognitive functioning is maintained close to the normal range in patients on CAPD.
Not surprisingly, improvements in cognitive performance have been reported in individuals who have undergone a kidney transplant. Recently, Kramer et al. (1996) reported on the effects of renal transplantation on cognitive performance. Cognitive functioning was measured by the P300, the Trailmaking Test, and the Mini-Mental State Examination. The tests were administered to 15 chronic hemodialysis patients pre-and post-transplant, and 45 matched healthy controls. Consistent with the results from Buoncristiani et al. (1993), the patients receiving hemodialysis (pre-trans-plantation) showed significantly impaired P300's, along with deficits on the Trailmaking Test and the MMSE compared to controls. Following transplant, there were no significant differences between the two groups on measures of cognitive performance. Results of this investigation suggest that cognitive impairments that may be present prior to transplant can be successfully reversed following transplant.
Table 30 Guidelines for Renal Diseases
(Reproduced with permission)
May need to assess other problems individually (such as hypertension,medication).
Patients with chronic renal failure are often able to continue to drive with the advent of hospital- and home-based intermittent hemodialysis programs, and the development of portable equipment for continuous peritoneal dialysis.
An individual requiring intermittent hemodialysis who wishes to drive more than 1 or 2 days distance from home cannot safely do so without making firm arrangements for dialysis at a conveniently located hospital.
Patients must be warned never to venture beyond the range of their customary hospital- or home-dialysis based unit without first making a firm appointment for dialysis elsewhere.
Continuous Peritoneal Dialysis Individuals who are able to manage (by themselves or with the assistance of others) can probably drive more or less as they wish, limited only by their ability to carry or obtain a continuing supply of fresh dialysis fluid.
The individual must be knowledgeable about his/her dialysis procedures and seek immediate assistance if problems should arise.
Should not drive for 4 weeks post-surgery.
Specialist opinion recommended*.
No restrictions following successful recovery.
Ongoing medical supervision a pre-requisite.
* Defined as a professional who assesses fitness-to-drive of those with a medical condition.
DLA = Driver Licensing Authority