RI clinicians share timely reviews in nephrology.

Much has changed since the launching in the US of the EndStage Renal Disease (ESRD) Program under Medicare on July 1, 1973, a unique entitlement program based solely on the presence of a clinical condition. Dialysis, initially a privilege for a select few, has exploded since then to become a multibillion dollar industry today, with over 600,000 patients on dialysis in the US, and over 1.6 million worldwide. The first patient on chronic hemodialysis was 39-yearold American Clyde Shields who had glomerulonephritis; he survived for 11 years. Today, the elderly population has the fastest growing ESRD rate, with often a large burden of comorbidities and very high mortality rates. Close to half of patients older than 75 years of age have some degree of chronic kidney disease (CKD), many of whom are at increased risk of cardiovascular disease and death. It is then very timely that this year’s theme for World Kidney Day, which occurred on March 13, 2014, was “CKD and aging.” On the other end of the age spectrum, the obesity epidemic has led to an increase in the rate of hypertension in the pediatric population. The metabolic syndrome/obesity epidemic is also likely responsible for the dramatic increase in nephrolithiasis rate. Previously largely regarded as a benign condition, nephrolithiasis is associated with huge costs of care and increased risk of acute kidney injury and CKD.