Figure 1 Risk factors that predispose renal dysfunction.
cardiovascular disease progression and sudden death.1 The number of people diagnosed with renal dysfunction has doubled since 1990 and is expected to nearly double again by 2010.1 Renal dysfunction often progresses to kidney failure and end-stage renal disease, requiring treatment with dialysis and kidney transplantation. End-stage renal disease has also progressively increased in developed countries. From 1997 to 2000, the incidence of end-stage renal disease among patients aged 65-74 and those greater than 75 increased to 7.8% and 22.3%, respectively.1
End-stage renal disease occurs when the kidney is no longer able to function normally to maintain fluid homeostasis. At this point, kidney function is so compromised that without dialysis or kidney transplantation, severe end-organ damage and death may occur from accumulation of fluids and waste products in the body. In the USA, nearly 300 000 people are on chronic dialysis and more than 20 000 have a functioning transplanted kidney.2 The cost of end-stage renal disease has exponentially increased to $18 billion for healthcare alone with $2-4 billion lost income for patients.
The incidence of renal dysfunction and end-stage renal disease is increased in racial minorities including African Americans, Hispanics, and Native American. For example, African American and Native American are four times more likely to develop renal dysfunction than Caucasians. The factors underlying kidney disease progression are not well understood; however, genetics, environment, and nutrition may all contribute to the development of renal dysfunction. Diabetes and hypertension are the leading causes of renal dysfunction nowadays.2 On the other hand, obesity is often associated with insulin resistance and may lead to diabetes and associated renal dysfunction. Taken together, hypertension, diabetes, and obesity account for over 70% of all the chronic kidney disease and end-stage renal disease cases (Figure 1).
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