Current issues and future perspectives of chronic renal failure.

Chronic renal disease is a major health issue in various parts of the world. The number of patients with end-stage renal disease (ESRD) is increasing in both developed and developing countries, greatly expanding the need for chronic dialysis and renal transplantation. In the year 2000, approximately 205,000 and 240,000 patients with ESRD were currently maintained on chronic dialysis in Japan and the United States, respectively, each accounting for roughly 20 and 24% of the estimated world chronic dialysis patients. The current cost for ESRD in Japan and the United States (including about 90,000 transplant recipients in the United States) amounts to approximately US$10 and 15 billion, respectively. Although some dialysis patients live longer than 5 to 10 yr and are able to work and contribute to the society in which they live, others fare poorly and die within 2 to 3 yr. In addition to mortality, another issue surrounding ESRD is a rapidly aging dialysis population, in part related to the fact that the major proportion of new patients entering dialysis programs comprises people with type 2 diabetes. These problems require the worldwide nephrology community to rededicate itself to the retardation and prevention of the progression of all forms of renal disease. This brief review discusses key issues on ESRD and the prevention strategy of chronic progressive renal disease. We will focus primarily on the issues in Japan and the United States because they represent and illustrate common problems pertaining to ESRD.