An improved understanding of the causes of end-stage renal disease

An understanding of the causes of end-stage renal disease (ESRD) is approached through a discussion of currently attributed causes, potentially unattributed causes, and the reasons for growth in new ESRD cases. The attributed causes of ESRD have varied over time and by region. In the United States, diabetes has long been the most common attributed cause of ESRD, accounting for 36% of incident cases in 1992. In contrast, diabetic ESRD is far less common in other countries. Hypertension and glomerulonephritis are the next most commonly attributed causes of ESRD, but these diagnoses are not necessarily based on consistent or uniform criteria. Mistaken classification of the cause of ESRD is possible in many cases. Emerging evidence suggests that other processes, including renovascular disease and analgesic ingestion, can cause or contribute to ESRD more often than they are recorded. The incidence of ESRD has been increasing at a rate of up to 9% per year. The likely reasons for ESRD growth include decreased competing risk from other diseases, increased referral and acceptance of patients with advanced renal failure, and increased renal disease.