End Stage Renal Disease

End stage renal Disease ( ESRD ) is diagnosed when kidney function drops to less than 15%. The Incidence rates of ESRD have increased steadily internationally  since 1989. The United States has the highest incident rate of ESRD, following Japan.

Kidney disease is the ninth leading cause of death in US.  As per  data from the United States Renal Data system ( USRDS ), there has been an increase of 104% in the  prevalence of chronic kidney failure between 1990–2001.  This increase is partially explained by the increase  in the prevalence of diabetes and hypertension,  the two most common causes of chronic kidney disease.

Other causes include ::  vascular injury, autoimmune disorders, infections, progressive stone disease causing obstruction to kidneys.  Factors other than the underlying disease process that may cause progressive kidney injury include following :

  • Acute injury from drugs toxic to kidneys, in patients with chronic kidney disease ( CKD ),
  • pain medicines over the counter other than acetominophen
  • Dehydration
  • Some types of  antibiotics
  • Contrast procedures, ie CAT scan with iodine contrast
  • Hyperlipidemia
  • Smoking
  • Old age.
  • Biologic process of aging initiates various structural & functional changes within the kidney.

Kidney mass decreases with age, thereby decreasing the kidney function.  Chronic kidney disease leading to ESRD is a major cause of morbity & mortality at later stages. Patients older than 65, mortality rates are 6 times higher than in general population.  Chronic kidney disease leading to ESRD affects all races, but in US, significantly higher incidence exists in blacks as compared to whites. Incidence rate for blacks is nearly 4 times higher than whites ESRD is higher for males compared to females.

 

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