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

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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.


Ann Intern Med. 2004;141(2):I-33. doi:10.7326/0003-4819-141-2-200407200-00002
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What is the problem and what is known about it so far?

Treatment of severe kidney disease, known as end-stage renal disease (ESRD), involves the use of difficult and expensive programs, such as dialysis or kidney transplantation. The number of patients entering ESRD programs has been increasing rapidly over the past 20 years despite improvements in managing less severe kidney problems. This increase may be caused by a true increase in the occurrence of kidney disease in the general population (with gradual worsening to ESRD), more liberal acceptance into ESRD treatment programs (people with less severe kidney disease being accepted for ESRD treatment), or improved survival from diseases that would otherwise have killed patients with underlying kidney disease before they became candidates for ESRD treatment.

Why did the researchers do this particular study?

To find out whether an increase in the occurrence of kidney disease in the general population could explain the increasing incidence of ESRD.

Who was studied?

8305 people (age 25 to 79 years) who participated in a nationwide survey of health status of the population, the National Health and Nutrition Examination Survey, from 1976 to 1980 (NHANES II) and 13,350 people of similar age who participated in the survey from 1988 to 1994 (NHANES III), as well as data from a comprehensive national registry of people receiving treatment for ESRD, the U.S. Renal Data System (USRDS).

How was the study done?

The researchers analyzed people with moderate chronic kidney disease (chronic renal insufficiency [CRI]) in NHANES II and III to evaluate how common kidney disease was at 2 different points in time. This information was then compared with data from the USRDS database on how many patients were being treated for ESRD.

What did the researchers find?

Between the 2 periods examined in this study, CRI became slightly more common, increasing from 1970 per 100,000 people to 2460 per 100,000 people, but the number of people with ESRD increased by a much greater proportion. Overall, only about 10% of the increase in ESRD could be explained by an increase in the occurrence of CRI.

What were the limitations of the study?

The level of kidney function could not be determined in about 25% of people in NHANES II because blood specimens were lost or not available for analysis. Furthermore, the researchers could not track specific individuals who had CRI in NHANES II or III until their development of ESRD.

What are the implications of the study?

Most of the increase in ESRD cannot be attributed to a general increase in CRI over time. Therefore, an increase in research expenditure and program development aimed at decreasing the incidence of CRI alone cannot solve the problem of the increasing incidence of ESRD.

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