++
ESSENTIALS OF DIAGNOSIS
Can afflict as many as 30% of patients with both type 1 and type 2 diabetes
Most common cause of end-stage renal disease (ESRD) in the western world, with >90% of patients having type 2 diabetes mellitus (DM)
Characterized by initial period of hyperfiltration, followed by development of increasing proteinuria and progressive decline in glomerular filtration rate (GFR)
Current therapy includes glycemic and blood pressure control and the use of renin–angiotensin–aldosterone system inhibitors
+++
GENERAL CONSIDERATIONS
++
Diabetes mellitus has become the single leading cause of chronic kidney disease in the world, and is the most common cause of ESRD in industrialized countries. The incidence and prevalence of diabetes has increased over the past 25 years, due almost entirely to increases in type 2 diabetes. In the United States, the prevalence of diabetes has increased from 6% of the population in 1988–1994 to 9.8% in 2009–2014. This rise in the prevalence of diabetes worldwide is multifactorial and has been attributed to increasing obesity due to decreased physical activity, institution of Western diets in developing countries and the increased use of high fructose corn syrup as a sweetener. Despite the improved care of patients with diabetes, both the incidence and prevalence of ESRD secondary to diabetes continue to rise. Over 26% of individuals in the United States with diabetes have evidence of diabetic kidney disease, and more than 30% of patients undergoing either dialytic therapy or renal transplantation have ESRD as a result of diabetic nephropathy. Almost 50% of the new (incident) cases of ESRD are attributable to diabetes. Currently, more than 200,000 patients receive ESRD care as a result of diabetic nephropathy.
++
In developed countries, more than 90% of patients with diabetes have type 2 rather than insulinopenic type 1 diabetes. Type 2 diabetes carries a similar risk for development of renal disease as Type 1, and over 80% of the ESRD secondary to diabetes is attributable to type 2 diabetes. The demographics of ESRD secondary to type 2 diabetes mirror the prevalence of type 2 diabetes in the US population, with a higher relative prevalence in African–Americans, Hispanic–Americans, Native Americans, and Asian–Americans and a peak incidence in the fifth to seventh decade. Recent epidemiologic studies have indicated that much of the increased mortality seen in patients with either type 1 or type 2 diabetes is associated with the prevalence of nephropathy. Diabetic patients with ESRD have a 1.5–2.5 fold increase in mortality compared to nondiabetic ESRD patients. The economic and social burden on the health care system of caring for patients with diabetic kidney disease is enormous. Given that the worldwide prevalence of obesity has increased more than fivefold in the past 20 years, an increasing incidence of diabetic nephropathy is being appreciated across the globe. These trends are especially worrisome in populations at increased risk of developing diabetes, especially Southeast Asians and Pacific Islanders.