**1. Introduction**

226 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice

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The incidence rates of End-stage renal disease (ESRD) have increased steadily internationally since 1989. The United States has the highest incident rate of ESRD, followed by Japan; Japan has the highest prevalence per million population, with the United States second (1). Of the 490,000 patients with ESRD in the United States, more than 380,000 are currently on hemodialysis (HD) (2).

ESRD on HD disproportionately affects minority populations. Whites represent the majority of the HD population (59.8%), while African Americans (33.2%), Asians (3.6%), and Native Americans (1.6%) comprise the rest of the ESRD population. However, the incidence rate of ESRD among African Americans is 4-fold higher and Native Americans 2-fold higher than that for whites. ESRD is slightly more prevalent in men than in women (male-to-female ratio, 1.2:1) and more prevalent in older adults (3).
