Hypertension, race and end-stage renal disease: a 25 year experience.

End-stage renal disease (ESRD) has a high prevalence in the United States with an incidence which is about four-fold higher in blacks compared to whites. In the population at large, diabetes mellitus is the leading cause of ESRD (33.8%) followed by hypertension (28.3%). In whites, diabetes mellitus prevails as the commonest etiology of ESRD, while in blacks, hypertension is the leading cause with almost forty percent of ESRD being secondary to hypertension. We report an analysis of the etiology of ESRD at inner city hospital which serves a predominantly black population, over a 25 year period from 1970 - 1994. 340 patients were seen with ESRD, requiring renal replacement therapy. 337 patients were black. The age of the patients ranged from 21 - 90 years with more than two-thirds between 30 - 60 years of age. There were 204 males and 136 females. Hypertension was the leading cause of ESRD (39%) followed by diabetes mellitus (27%). Intravenous drug abuse and HIV associated nephropathy each accounted for 9% of ESRD. Glomerular disease was an uncommon etiology at 3%. A timed analysis of the data for five consecutive five year periods from 1970 - 1994, showed that the incidence of treated hypertensive ESRD increased 100% over the 25 year period. The proportion with hypertensive etiology for ESRD remained relatively stable, however. In conclusion, (i) the incidence of hypertensive ESRD has risen by a dramatic 100% over a 25 year period in this inner city population; and (ii) hypertension remains the leading cause of ESRD in the black patient population, with a 1.5 fold higher incidence than diabetes, and this has remained unchanged in the last quarter century.