Chronic kidney disease is rising rapidly worldwide and is becoming a global healthcare problem, warn experts in this week’s BMJ.

In the United Kingdom, the annual incidence of end stage renal disease is around 100 per 1,000,000 population. This figure has doubled over the past decade and is expected to continue to rise by 5-8% annually, but it still remains well below the European average (around 135/1,000,000) and that of the United States (336/1,000,000).

The rise in end stage renal disease worldwide probably reflects the global epidemic of type 2 diabetes and the ageing of the populations in developed countries (the annual incidence in people over 65 in the UK is greater than 350/1,000,000, and in the US it is greater than 1,200/1,000,000).

The number of people with diabetes worldwide, currently around 154 million, is also set to double within the next 20 years, and the increase will be most notable in the developing world, where the number of patients with diabetes is due to reach 286 million by 2025.

The cost of treating end stage renal disease is substantial and poses a great challenge to provision of care. In Europe, less than 0.1% of the population needs renal replacement therapy, which accounts for 2% of the healthcare budget. In the US, the annual cost of treatment for end stage renal disease is expected to reach $29 billion by 2010. Few countries will be able to meet these growing medical and financial demands.

More than 100 developing countries, with a population in excess of 600 million, do not have any provision for renal replacement therapy. Consequently, more than a million people may die every year worldwide from end stage renal disease.

Programmes to detect chronic kidney disease, linked to comprehensive primary and secondary prevention strategies, are needed urgently, say the authors.

Mass population screening for chronic kidney disease is neither practical nor likely to be successful or cost effective. But structured and well resourced programs targeting at risk individuals, such as those suffering from diabetes and hypertension, along with primary prevention programmes based on reducing risk factors across the whole population could make a big difference.

The authors believe that such an approach to risk reduction may slow or even reverse declining renal function.