Epidemiology and causes of chronic renal failure

Recent studies have shown that the prevalence of chronic renal failure (CRF) is higher than was widely believed. The prevalence of renal replacement therapy (RRT) is rising progressively, although the rising incidence has stabilized in some developed countries. Needs may differ widely between countries depending on ethnic mix, social deprivation, prevalence of diabetes, and quality of healthcare. Diabetic nephropathy is the single most common cause of CRF, leading to over 40% of RRT in some countries, and will increase significantly in the next decade. Making a precise renal diagnosis identifies reversible causes, predicts prognosis, predicts recurrence after transplantation and aids counselling in familial conditions. Renal failure is less common in children than in adults, with a different spectrum of causes. Renal failure is common in developing countries, particularly in tropical areas and in young individuals: secondary glomerular diseases related to infection are common. RRT is an expensive but effective therapy, which will inevitably consume increasing resources in the next decade as numbers grow and the growing proportion of elderly patients and others with co-morbid conditions and social problems will place greater demands on healthcare resources.