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The Incidence of End-Stage Renal Disease Is Increasing Faster than the Prevalence of Chronic Renal Insufficiency

Chi-yuan Hsu, MD, MSc; Eric Vittinghoff, PhD; Feng Lin, MS; and Michael G. Shlipak, MD, MPH
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From the University of California, San Francisco, San Francisco, California.


Acknowledgments: The authors thank Dr. Ann O'Hare, Dr. Charles McCulloch, and Ms. Michelle Odden for their assistance.

Disclaimer: Some of the data reported here were supplied by the U.S. Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the United States government.

Grant Support: By the National Institutes of Health (grants DK61520 [Dr. Hsu] and HL68099 [Dr. Shlipak]). Dr. Shlipak was also supported by the Health Services Research and Development Service of the Veterans Affairs Administration (Advanced Research Career Development Award), American Federation for Aging Research (Paul Beeson Scholars Program), and Robert Wood Johnson Foundation (Generalist Scholars Program).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Chi-yuan Hsu, MD, MSc, Division of Nephrology, University of California, San Francisco, 513 Parnassus Avenue, 672 HSE, Box 0532, San Francisco, CA 94143-0532; e-mail, hsuchi@medicine.ucsf.edu.

Current Author Addresses: Dr. Hsu: Division of Nephrology, University of California, San Francisco, 513 Parnassus Avenue, 672 HSE, Box 0532, San Francisco, CA 94143-0532.

Dr. Vittinghoff: University of California, San Francisco, 1635 Divisadero Street, Suite 600, San Francisco, CA 94115.

Ms. Lin: University of California, San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105.

Dr. Shlipak: Veterans Affairs Medical Center, 4150 Clement Street (111A1), San Francisco, CA 94121.

Author Contributions: Conception and design: C.Y. Hsu, M.G. Shlipak.

Analysis and interpretation of the data: C.Y. Hsu, E. Vittinghoff, F. Lin, M.G. Shlipak.

Drafting of the article: C.Y. Hsu, M.G. Shlipak.

Critical revision of the article for important intellectual content: C.Y. Hsu, E. Vittinghoff, F. Lin, M.G. Shlipak.

Final approval of the article: C.Y. Hsu, E. Vittinghoff, F. Lin, M.G. Shlipak.

Statistical expertise: C.Y. Hsu, E. Vittinghoff, F. Lin.

Obtaining of funding: C.Y. Hsu, M.G. Shlipak.


Ann Intern Med. 2004;141(2):95-101. doi:10.7326/0003-4819-141-2-200407200-00007
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Our results clearly show that the epidemic of ESRD cannot be explained by the increased prevalence of kidney disease in the United States. We found that increases in ESRD incidence outpaced the increase in chronic renal insufficiency prevalence by 70% during the past 2 decades. By using a Poisson multivariate regression analysis, we found that only about 10% of the growth in ESRD cases could be attributed to increased chronic renal insufficiency in the adult population, an effect smaller in magnitude than that attributed to simple population growth. We conclude that Port's other 2 considerations—more liberal entry into dialysis (and transplant) programs and improved survival from competing causes among persons with chronic renal insufficiency, resulting in greater longevity and eventual need for ESRD (3)—are the dominant contributors to the increasing number of newly treated ESRD cases.

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Figure.
Numbers of cases of newly treated end-stage renal disease (ESRD) among black and white patients, 25 to 79 years of age, in the United States from 1985 to 1996.

Model A. Observed (unadjusted) rate of increase in incidence (estimated rate, 8.0% per year). Model B. Adjusted rate for population growth and demographic characteristics (estimated rate, 6.9% per year). Model C. Adjusted rate for population growth, demographic characteristics, and chronic renal insufficiency prevalence (estimated rate, 6.1% per year).

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Summary for Patients

Possible Causes of the Increasing Incidence of End-Stage Renal Disease

The summary below is from the full report titled “The Incidence of End-Stage Renal Disease Is Increasing Faster than the Prevalence of Chronic Renal Insufficiency.” It is in the 20 July 2004 issue of Annals of Internal Medicine (volume 141, pages 95-101). The authors are C.Y. Hsu, E. Vittinghoff, F. Lin, and M.G. Shlipak.

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