End-stage renal disease: a southern epidemic

During the past decade, the annual incidence of patients entering long-term dialysis for end-stage renal disease (ESRD) has been increasing, while mortality from stroke and coronary artery heart disease has been decreasing. In the Southeast, hypertension is the most common cause of ESRD, followed closely by diabetes mellitus occurring most frequently in older minority patients, particularly blacks. The causes of the increase in ESRD are not known. Although control of any degree of hypertension with any antihypertensive drug will slow the progression of renal failure from any cause, captopril, an angiotensin-converting enzyme (ACE) inhibitor, has been shown to slow progressive renal failure in patients with insulin-dependent diabetes mellitus to a greater degree than that expected from only its antihypertensive effect. This series of articles, originally presented at the 1993 annual meeting of the Southern Medical Association, reviews the epidemiology and pathophysiology of ESRD and offers a clinical approach to this serious problem.