Nutrition in ESRD patients: rationale and plan for an initiative.

End-stage renal disease (ESRD) continues to be a major public health problem in the United States. There has been an exponential growth in the incidence rate, at an average of 5% to 8% per year over the past decade. Dialysis remains the predominant therapeutic modality. Unfortunately, however, the morbidity and mortality rates remain unacceptably high for the dialysis patient population. Malnutrition has been consistently suggested as a major contributor to the high morbidity and mortality rates. However, the exact magnitude of the problem is poorly defined. The physiological and pathophysiological mechanisms have not been adequately determined. Finally, any interventional approach and its potential beneficial effect are yet to be carefully defined and explored. This National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) initiative, with input from the ad hoc advisory committee, and strengthened with public comments, is intended to address these deficiencies, and the broad issue of nutrition and nutritional derangement and their detrimental effects on the ESRD patient population.