The progression of chronic renal failure: An unmet challenge

An increasing number of patients require dialysis replacement therapy every year in Europe. This reflects the large number of patients with chronic renal failure (CRF) and the progressive nature of their underlying nephropathies. Worldwide, the annual incidence of acceptance rates on renal replacement programmes varies between 25 patient per million of population (pmp) in some developing countries to 58.6 pmp in Europe, 169 pmp in the USA [I] and 194.2 pmp in Japan [2]. In Europe, there are in excess of 312 pmp on replacement therapy with France having one of the highest prevalence within the continent with 628 pmp [3]. Further, there are important differences in the incidence of end stage renal failure (ESRF) according to age, gender and race. In Western countries, the incidence of ESRF is lowest in children (10 pmp/year) and highest in the elderly (> 400 pmp/year in patients over the age of 75). The incidence of ESRF is higher in males. In the United States, the incidence of ESRF is higher in Afro-Carribeans and native Americans [4]. This reflects both an increased prevalence of CRF in these ethnic minorities as well as a higher rate of progression [4]. It also reflects the higher incidence of systemic hypertension and diabetic nephropathy in black and native Americans respectively [4].In the United Kingdom, the incidence of ESRF is higher in Asians [5].