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Diabetes and Kidney Disease: The need for Early Diagnosis and Treatment
July 2003

Kidney disease caused by diabetes is the commonest cause worldwide of kidney failure requiring treatment by dialysis or kidney transplantation. Early kidney damage can be detected by simple urine testing for a specific protein albumin. The risk of kidney failure, and the rate at which it develops, can be reduced by good blood glucose and blood pressure control. Early referral to kidney specialists improves survival as the kidneys fail. Many people with diabetes do not have access to good clinical care, urine testing to detect early kidney damage and dialysis or transplantation when the kidneys do fail.

IDF’s position is that Kidney disease caused by diabetes (diabetic nephropathy) is the commonest single identifiable cause worldwide of kidney failure requiring dialysis or kidney transplantation. The highest annual incidence is in the USA, where over 40 % of people requiring treatment for kidney failure have diabetes (around 107 people with diabetes per million population). The number of people with diabetes with kidney failure is increasing in most countries. Dialysis costs around 30000 ⑚¬ per person per year and a kidney transplant approximately 13000 ⑚¬ in the first year and over 5000 EUR per year thereafter.

Diabetic kidney disease develops slowly over 20–30 years of diabetes. Approximately 25 % of people with type 1 diabetes and 5–10 % of those with type 2 diabetes develop kidney failure. However, because type 2 diabetes is at least 10 times as common as type 1 diabetes, the majority of people with diabetes and kidney failure have type 2 diabetes. People of non–Caucasian origin are at higher risk than Caucasians. The risk of kidney damage and the rate at which it progresses is increased by a number of factors, particularly poor blood glucose control and high blood pressure.

Damage to the kidney can be detected at an early stage by urine testing to measure the amount of a specific protein albumin. International guidelines recommend that everyone with diabetes should have such a urine test performed annually. If early kidney damage is found, very tight control of blood pressure, using particular types of blood–pressure lowering medication, will slow the rate at which kidney failure develops. With good care, it may be possible to prevent the development of diabetic kidney disease. At the very least, it is possible to delay the need for dialysis or transplantation for 10–20 years.

However, in many people with diabetes, blood glucose and blood pressure control are not ideal and thus their risk of developing diabetic kidney disease is higher than it need be. There is evidence that many people with diabetes are not offered the annual urine test to identify those who are developing diabetic kidney disease and that those with early kidney damage are not prescribed the particular blood pressure–lowering drugs and other treatment which will delay further kidney deterioration. As the kidneys begin to fail, early referral to a kidney specialist is essential, for further assessment and planning for dialysis or transplantation. Such early referral improves outcome. However, many people with developing kidney failure are not referred until the kidneys have failed completely.

The numbers of people with diabetes on dialysis or having a kidney transplant varies widely between countries. Some of this variation may be due to different prevalence of diabetes and different susceptibility to developing kidney disease. However, the large variation also reflects the fact that in some countries, dialysis or transplantation is not readily available to people with diabetes, because of limited resources and discrimination against those with diabetes.

IDF recommends that everyone with diabetes should be helped to achieve optimal blood glucose and blood pressure control to reduce their risk of developing kidney failure due to diabetes, that annual urine testing to identify individuals with early kidney disease should be offered to everyone with diabetes, that those with signs of kidney damage be offered appropriate treatment, including specific blood pressure lowering drugs, that individuals with developing kidney failure should be referred in a timely fashion to kidney specialists, and that everyone with kidney failure due to diabetes should have access to dialysis or a kidney transplant.

References:
Diabetes and Kidney Disease: Time to Act, International Diabetes Federation, 2003

Source: International Diabetes Federation