[The chronic renal failure epidemic: an underestimated public health problem]. / L'epidemia d'insufficienza renale cronica. Un sottovalutato problema sanitario di prima grandezza.

Renal failure is considered a rare disease. However, recent epidemiological surveys like the NHANES III survey in the USA have shown that mild and moderate renal insufficiency is much more common: 31% and 4% of Americans, respectively, are affected by a mild or moderate degree of renal insufficiency. Such an epidemic is of particular concern because of the high cardiovascular risk brought about by kidney failure. Renal insufficiency is now considered a public health priority. Together with diabetes and smoking, the metabolic syndrome is the principal factor responsible for this epidemic. The prevalence of chronic renal insufficiency is in fact strictly proportional to the number of components of the metabolic syndrome being present in individual patients. As renal function deteriorates, other risk factors come into play like those peculiar to renal insufficiency (anemia, hyperparathyroidism) and some so-called emerging risk factors (inflammation, hyperhomocysteinemia and high plasma levels of endogenous inhibitors of NO synthase such as asymmetric dimethylarginine).