Last update:
16-Jun-2006

The number of patients in renal replacement therapy (RRT) with hemodialysis (HD), peritoneal dialysis (PD) or renal transplantation (RTx) has increased dramatically over the past decades. Although the rate of increase in developed countries is being consistently reduced, a significant increase in the total number of these patients is expected worldwide, due to the spread of RRT application in the developing world. The main cause of this phenomenon, in the financially robust countries, is the increase of the incidence of patients, particularly those who are older than 65 years and diabetic type 2 patients. Increased survival, earlier initiation of RRT, increased prevalence of arterial hypertension and more flexible criteria of enrollment are all contributing factors. In developing countries the increase is mainly due to the improvement of the financial capacity of health authorities to fund a continuously increasing application of RRT methods. The increase of patients in RRT creates serious economic, ethical and social problems, due to the burden of providing RRT facilities and the expenses for dialysis reimbursements. Therefore, diminishing the prevalence of end-stage renal disease (ESRD) and the correct choice of the most suitable RRT modality appear to be important parameters in ameliorating the consequences of this phenomenon. The aim of this review is to evaluate the magnitude of the problem of ESRD, to explain and analyze its causes and the differences between the various countries and to suggest measures that could moderate the consequences of the increased number of patients in RRT.

Key words: ESRD, Incidence, Prevalence, Replacement of renal function.