Clinical epidemiology in chronic uremia.

The burden of disease in end-stage renal disease (ESRD) is high. The cost of end-stage renal disease therapy is also high. The age and co-morbidity of patients is increasing, and many patients are started on therapy with little hope of rehabilitation, and with a high likelihood of death within a short period of time. Data from large prospective studies are necessary to help patients and doctors to make decisions concerning the initiation and cessation of dialysis. Inadequate dialysis and malnutrition may adversely influence clinical outcome, and cardiovascular disease exerts a large influence on morbidity and mortality. Clinical trials are necessary concerning the effect on clinical outcome of dialysis prescription, interventions to improve malnutrition, hypertension, anemia, hyperparathyroidism, hyperlipoproteinemia, and diabetes mellitus.