The number of patients with chronic kidney disease worldwide is rising markedly.1 In the United Kingdom, the annual incidence of end stage renal disease is around 100 per 1 000 000 population.2 This incidence has doubled over the past decade and is expected to continue to rise by 5-8% annually, but it remains well below the European average (around 135/1 000 000) and that of the United States (336/1 000 000).3

Disparities in the incidence of end stage renal disease within and between developed countries reflect racial and ethnic diversity. In the US, the annual incidence is 256/1 000 000 in white people compared with 982/1 000 000 in African-Americans.3 In Australia, the incidence in white people is comparable to that in the UK (94/1 000 000), but the incidence in aboriginals is 420/1 000 000.

The rise in end stage renal disease worldwide most probably reflects the global epidemic of type 2 diabetes and the ageing of the populations in developed countries, with a higher incidence in elderly people (the annual incidence in people over 65 in the …