Where Is the Epidemic in Kidney Disease?

ESRD

According to the latest U.S. Renal Data System (USRDS) Annual Report, the annual incidence of ESRD in the United States is 354 per million person-years in 2007 (adjusted for age, gender, and race),³ representing a slight drop from the prior year. This secular trend is quite different from that observed in the 1980s and 1990s when the incidence of ESRD increased at a rapid rate. In fact, the adjusted incidence of ESRD has more or less reached a plateau in the 7 prior years (Figure 1).³ The corresponding unadjusted incidence rates are 334.2, 338.2, 342.8, 347.1, 353.8, 364.7, and 361.0 per million person-years in 2001, 2002, 2003, 2004, 2005, 2006, and 2007, respectively,⁴ which represents an increase of about 1% per year.

It is notable that this slow growth in ESRD incidence is observed despite the fact that mean serum creatinine at the start of renal replacement therapy has dropped substantially in the past decade (Figure 2). This secular trend is almost certainly due to changes in practice pattern and more liberal initiation of dialysis, and hence would increase the number of ESRD patients even if there were no change in the underlying burden of kidney disease in the population. …