End-stage renal disease: magnitude of the problem, prognosis of future trends and possible solutions.

The incidence rate per million population of treated end-stage renal disease (ESRD) has been increasing at similar rates in most countries that record counts of new ESRD patients per year. Data from the United States Renal Data System (USRDS) suggest an exponential growth for both incidence rates and prevalence rates. Doubling of the number of new patients per year occurred over a recent 8.5 year period, and this interval was even shorter for older patients, Asians, Native Americans and for patients with diabetes or hypertension as cause of ESRD. Reasons for this growth in incidence include greater acceptance to therapy of older and sicker patients, reduced mortality from other conditions and possibly more kidney disease. A recent reduction in mortality rates for ESRD patients in the US has additionally influenced the growth in prevalence. In view of these striking recent trends a prognosis for the next decade is discussed. As major possible solutions prevention efforts for renal disease and for the progression of renal disease are proposed, as are means to enhance renal organ donation.