Chronic kidney disease (CKD) is currently considered an increasing public health problem that may be ameliorated by greater patient and physician awareness, better and earlier detection, and timely management.1,2 In the past, the increasing numbers of patients with end-stage renal disease (ESRD) who received renal replacement therapy (dialysis and transplantation) seemed to be fueled by a large and increasing population of patients with CKD, but renal replacement therapy incidence rates have reached a plateau in the United States and in many other developed countries of the world.3(pps231,s348) The so-called epidemic of CKD has largely abated, at least in industrialized nations. Although this may have been due in part to early detection and better management programs that resulted in slowing the rate of progression of CKD to ESRD, the reasons for the declines in rates of ESRD treated with renal replacement therapy remain obscure.
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