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Commentary |

Chronic Kidney Disease and the Public Health:  Gaps in Evidence From Interventional Trials

Jonathan Himmelfarb, MD
JAMA. 2007;297(23):2630-2633. doi:10.1001/jama.297.23.2630.
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In recent years, chronic kidney disease has received increased attention as a leading public health problem.1 The kidney disease burden, measured in terms of prevalence, associated economic costs, and morbidity, is substantial and increasing. In the United States, more than 400 000 individuals have end-stage renal disease (ESRD),2 for which life can be sustained only with renal replacement therapy such as dialysis or kidney transplantation. In a recent population-based study of US residents 45 years and older, 9.5% had a first-degree relative with ESRD.3 It is estimated that by 2015, more than 700 000 individuals in the United States will have ESRD, and more than 107 000 ESRD-related deaths will occur annually.2 Cardiovascular mortality in patients with ESRD is 10- to 20-fold higher than in the general population and is the leading cause of death.4 Mortality rates for patients with ESRD have shown only modest improvement over the past 2 decades.

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