[Epidemiology and etiology chronic renal insufficiency]

End-stage renal failure (ESRF) is a medical and a public health problem in France and in developed countries due to the increased incidence (100 per million of persons (pmp) in France, in 1998 /year) and prevalence rates (600 pmp in 1998; +8%/year) and due to the high cost of the renal replacement therapy (RRT). This increase is mainly due to the increased incidence and prevalence of type 2 diabetic and vascular nephropathies that represent more than 50% of the ESRF causes. This progression is the consequence of an access to RRT for patients older than 60, of the population ageing, and of a better prevention and management of cardio-vascular complications in elderly ans diabetic patients. More than 30% of the patients are referred too late, leading to an increased morbi-mortality. Clear recommendations are required to make an early diagnosis of renal failure (plasma creatinine > or = 137 mumol/L in man and > or = 104 mumol/L in woman), mainly in the group of at risk patients and in order to improve the management of these patients before the end-stage renal disease.