End-stage renal disease and race: an overview and perspective

The epidemiology of end-stage renal disease (ESRD) in the United States is reviewed. Hypertension and diabetes as etiologic factors in ESRD in minorities are discussed, as is the question of a familial ESRD. It is hypothesized that diuretics as sole antihypertensive therapy in blacks may in the long term result in chronic volume contraction, increased sympathetic stimulation, and therefore, decreased renal function. As such, a rational basis for the long-term use of diuretics as the sole antihypertensive therapeutic in blacks becomes questionable at best.