Diabetic nephropathy

Diabetes mellitus (DM) remains the most common primary cause of incident and prevalent chronic kidney disease (CKD) requiring renal replacement therapy in the United States1 and the emerging world.2 In the United States, more than 43% of the new CKD diagnoses in 2004 were attributable to diabetes: a total of 45,871 patients, a rate of 149 per million/population. Although the absolute number of new CKD patients each year is increasing due to population growth, the rate of incident CKD from diabetes has decreased since the year 2000. This trend is reassuring, although CKD attributable to DM remains unacceptably high among blacks, Hispanics, and Native Americans; and continues to increase in the elderly and younger (age 30-39) black adults. The economic impact of advanced kidney disease from diabetes is enormous - total CKD expenditure in 2004 was $32.5 billion, and diabetic patients incur the highest per-person per-year cost. Patients with diabetes have the highest hospitalization rates and mortality (cardiovascular, infectious, and all-cause) among all dialysis patients. They are also less likely to be wait listed for or to receive a kidney transplant. Diabetic individuals fare worse than nondiabetic patients after transplantation, with higher mortality and morbidity from infection.