Incidence of end-stage renal disease: magnitude of the problem and its implications.

Data on incidence and prevalence rates of end-stage renal disease (ESRD) from selected countries including Saudi Arabia are provided. Current data from this country suggest that the incidence of treated ESRD (t-ESRD) in the age-group 0-20 years is 14 per million population (PMP) while the combined incidence for all ages is 240 PMP. The cost of management of the patients is staggering. In Japan, it has been estimated that the projected prevalence of t-ESRD will be 1111 PMP needing an estimated budget of US $ 5.8 billion per year for their management. Globally, more than US $ 50 billion would be needed per year with the presently available treatment modalities. This financial liability might make "Health for all by the year 2000" a myth unless some cheaper method of treatment is made available. Vigorous research is needed towards identifying and prioritizing vulnerable groups for ESRD by identifying and properly managing at-risk groups. These include patients with diabetes mellitus and hypertension as well as patients with indicators like proteinuria and obstructive uropathy. Cheaper modes of renal replacement therapy should be sought. Interesting ideas such as induction of diarrhea for amelioration of renal failure need to be explored further as also the use of the patient's own intestine as a medium for molecular exchange.