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Epidemiology of diabetic nephropathy


Authors: I. Rychlík
Authors‘ workplace: Diabetologické centrum II. interní kliniky 3. lékařské fakulty UK a FN Královské Vinohrady Praha, přednosta prof. MUDr. Michal Anděl, CSc.
Published in: Vnitř Lék 2008; 54(5): 488-493
Category:

Předneseno na 9. celostátním diabetologickém sympoziu Diabetes a urogenitální systém ve dnech 1.-2. června 2007 v Novém Adalbertinu v Hradci Králové

Overview

The epidemiology of diabetic nephropathy (DN) should be approached from two angles: a) incidence of diabetic nephropathy in patients with diabetes, and b) epidemiology of chronic renal failure (CHRF) in diabetic patients. According to data from different sources, DN affects, in all its stages, about one third of patients irrespective of the type of diabetes they suffer from, with the peak rate of incidence after 15 years of duration of the illness. It is estimated that the rate of DN prevalence is 4–8% of patients monitored in diabetes centres. In addition, a significant portion of diabetics, especially the type 2 diabetic patients, are affected by the non-diabetic type nephropathy of primarily atherosclerotic etiology. Currently, DN is the principal cause of CHRF in advanced industrial countries (Western Europe, USA, Japan). A similar trend has been recorded in the Czech Republic which has one of the highest incidences of DN among the former Eastern Block countries. Most affected patients are type 2 diabetes patients. The cause of the above increase is the growing prevalence and incidence of type 2 diabetes, and, primarily, better care for type 2 diabetes patients who live long enough to develop severe macro and microvascular complications including DN. The principal factors influencing the risk of a diabetic patient developing DN are long-term monitoring of glycaemia, control of hypertension, genetic (ethnic) factors, age and sex. Metabolic control has an effect on the risk of diabetic nephropathy developing in type 1 and 2 diabetes, yet it is blood pressure control which is critical for the progression of chronic renal insufficiency in DN patients. In view of the high number of diabetic patients with CHRF which, in addition, associates with their high polymorbidity and extensive demands put on medical and nursing care which is not directly associated with CHRF therapy, we have to do with a serious medical and economic problem.

Key words:
diabetes mellitus – diabetic nephropathy – chronic renal failure – regular dialysis therapy


Sources

1. Rychlík I, Miltenberger-Miltenyi G, Ritz E. The drama of the continuous increase in end-stage renal failure in patients with type II diabetes mellitus. Nephrol Dial Transplant 1998; 13(Suppl 8): 6-10.

2. Ritz E, Rychlík I, Locatelli F et al. Endstage renal failure in type 2 diabetes - a medical catastrophe of worldwide dimensions. Am J Kidney Dis 1999; 34: 795-808.

3. Rychlík I, Berdych M. Epidemiologie diabetické nefropatie. In: Rychlík I, Tesař V (eds). Onemocnění ledvin u diabetes mellitus. Praha: Tigis 2004: 127-138.

4. Orchard TJ, Dorman JS, Maser RE et al. Prevalence of complications in IDDM by sex and duration. Pittsburgh Epidemiology of Diabetes Complications Study II. Diabetes 1990; 39: 1116.

5. Parving HH, Hommel E, Mathiesen E et al. Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin dependent diabetes. Br Med J 1988; 296: 156.

6. Bojestig M, Arnqvist HJ, Hermansson G et al. Declining incidence of nephropathy in insulin-dependent diabetes mellitus. N Engl J Med 1994; 330: 15.

7. Krolewski M, Eggers PW, Warram JH. Magnitude of end-stage renal disease in IDDM: a 35 year follow-up study. Kidney Int 1996; 50: 2041.

8. Matsushima M, Tajima N, LaPorte RE et al. Markedly increased renal disease mortality and incidence of renal replacement therapy among IDDM patients in Japan in contrast to Allegheny County, Pennsylvania, USA. Diabetes Epidemiology Research International (DERI) U.S.-Japan Mortality Study Group. Diabetologia 1995; 38: 236.

9. Cowie CC, Port FK, Wolfe RA et al. Disparities in incidence of diabetic end-stage renal disease according to race and type of diabetes. N Engl J Med 1989; 321: 1074.

10. Pavkov ME, Knowler WC, Bennett PH et al. Increasing incidence of proteinuria and declining incidence of end-stage renal disease in diabetic Pima Indians. Kidney Int 2006; 70: 1840.

11. Adler AI, Stevens RJ, Manley SE et al. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003; 63: 225.

12. Ritz E, Orth SR. Nephropathy in patients with type 2 diabetes mellitus. N Engl J Med 1999; 341: 1127.

13. Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kidney Dis 1996; 27: 167.

14. Ballard DJ, Humphrey LL, Melton LJ et al. Epidemiology of persistent proteinuria in typus II diabetes mellitus. Population-based study in Orchester, Minnesota. Diabetes 1988; 37: 405-412.

15. Rychlík I, Ritz E, Halimi S et al. Epidemiology of endstage renal disease in type 2 diabetes. In: Ritz E, Rychlík I (eds). Nephropathy in type 2 Diabetes. Oxford: Oxford University Press 1999: 246-266.

16. Ghavamian M, Gutch CF, Kopp KF et al. The sad truth of hemodialysis in diabetic nephropathy. JAMA 1972; 222: 1386-1389.

17 Raine AEG (on behalf of the EDTA Registry). Epidemiology, development and treatment of end stage renal failure in non insulin dependent diabetics in Europe. Diabetologia 1993; 36: 1099-1104.

18. Renal Data System, USRDS 1999 Annual Data Report. Bethseda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases 2000.

19. Ramsteijn PG, de Charro FT, Geerling W et al. 1998 Registratie nierfunctievervanging Nederland. Stichfing RENINE. Rotterdam: Statistisch Verlag 1998.

20. Rodríguéz JA, Clèries M, Vela E and Renal Registry Committee. Diabetic patients on renal replacement therapy: analysis of Catalan. Nephrol Dial Transplant 1997; 12: 2501-2509.

21. Ismail N, Becker BN, Strzelczyk P et al. Renal Disease and Hypertension in Non-Insulin-Dependent Diabetes Mellitus (editorial). Kidney Int 1999; 55: 1-28.

22. Rychlík I. Epidemiologie diabetické nefropatie. In: Perušičová J (ed). Trendy soudobé diabetologie. Praha: Galén 2003. Vol. 7: 15-23.

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