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Can we prevent end-stage renal disease due to hypertension or to diabetes mellitus?

In the United States, there are about 200 000 patients with end-stage renal disease (ESRD) who either are being treated by long-term dialysis or have a functioning kidney transplant. Over 40 000 new patients need to start such renal replacement therapy each year. Two thirds of this ESRD is now due to two "treatable" systemic diseases. Because it is more common, type II diabetes mellitus causes more ESRD than type I, and causes it in older patients. The other main cause, hypertensive nephrosclerosis, causes ESRD mainly in older whites, whereas it is an important cause of ESRD in young adult and middle-aged African Americans. See also pp 3079 and 3085. The prevalence of ESRD is significantly higher in African Americans for all causes except congenital ones such as polycystic disease.1-3The black:white ratio for ESRD due to hypertensive nephrosclerosis approaches 20:1 in the age group 25 to 45 years.