US kidney failure rates stabilize (Reuters)

NEW YORK (Reuters Health) - Since 1999, rates of kidney failure in the United States have stabilized, ending a two-decade climb in which rates rose by 5 percent to 10 percent each year, according to a recent report by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a branch of the National Institutes of Health.

The report, which is to be presented next month at the annual scientific meeting of the American Society of Nephrology, indicates that in 2003, there were 338 new cases of kidney failure per million population, which is slightly lower than the rate recorded in 2002. From 1999 to 2003, the rate has not increased or decreased more than 1 percent, whereas an average annual increase of 5 percent was seen in the previous decade.

"These findings are encouraging and suggest we may be seeing the light at the end of the tunnel," Dr. Paul W. Eggers, co-director of the NIDDK's US Renal Data System, told Reuters Health. "For many, many years, it just seemed like (kidney failure) rates would go up forever."

Eggers attributes the plateau in kidney failure rates to increased use of drugs thought to protect the kidneys and improve control of diabetes and blood pressure, such as ACE-inhibitors and angiotensin receptor blockers (ARBs).

But not all of the news is good.

Racial disparities in kidney failure persist. For whites under 40 years of age, the incidence of diabetes, the leading cause of kidney failure, has reached its lowest since the late 1980s, whereas for African Americans, little change has occurred.

The cost of kidney failure continues to be a major burden for the healthcare system. In 2003, close to 537,000 people were on dialysis or had received a kidney transplant and the cost to Medicare was $18.1 billion.

Tests to diagnose kidney disease at earlier, more treatable stages are underused and despite increases in the use of ACE-inhibitors and ARBs, many eligible patients are not receiving these drugs.

One key to addressing these issues is raising awareness about kidney disease, Dr. Eggers said, citing the NIDDK's recently developed National Kidney Disease Education Program. "For both patients and physicians, we are trying to get the word out. It's a little bit like the 'know your number' campaign they used to have for high blood pressure, but in this case, it's the glomerular filtration rate."