Ethnicity and renal disease: questions and challenges.

There are significant ethnic variations in the incidence of end-stage renal disease (ESRD). In the UK, the incidence of ESRD in South Asians and African Caribbeans is three times higher than in White Caucasians. This is partly explained by a high prevalence of diabetic nephropathy, but also by susceptibility to a wide range of other renal diseases. The relative contributions of genetic and environmental factors to this susceptibility are not yet well understood. The age structure of the population indicates that the prevalence of ESRD in ethnic minority populations will continue to increase more rapidly than in the White Caucasian population. Additional resources are required for renal replacement therapy in areas with substantial ethnic minority populations, taking into account the increased waiting times for cadaveric renal transplantation in these populations. Early intervention programmes to delay or prevent renal failure must be targeted to these high-risk populations.