The consequences and costs of chronic kidney disease before ESRD

Given the large number of US patients with end-stage renal disease (ESRD) and the attendant costs to the health care system, the renal community over the past decade has largely focused on patients with ESRD, a focus reinforced by the availability of a remarkable data source in the United States Renal Data System (USRDS). Our community has addressed adequacy of dialysis, appropriate treatment of anemia, dialysis access, and other similar issues. Similarly, the main focus of clinical trials in patients with chronic kidney disease (CKD) before ESRD has been on prevention of progression to ESRD. This focus has undeniably been beneficial to our patients. We have seen a decline in the incidence of ESRD due to glomerulonephritis and probably of type I diabetes mellitus (1), a marked improvement of the fraction of ESRD patients receiving appropriate doses of dialysis and achieving better hematocrits, and a parallel decline in the mortality among patients with ESRD (1).