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Diabetic nephropathy
V. SECONDARY GLOMERULAR DISORDERS
CHAPTER 34
DIABETIC NEPHROPATHY Yalemzewd Woredekal, MD, and Eli A. Friedman, MD
Number of new cases of ESRD
50,000
320 Number Rate
300
40,000 280 30,000
260 240
20,000 220 10,000
02
01
20
00
20
99
20
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
19
19
90
200
Per 100,000 persons with diabetes
1. Concurrent with the global pandemic of diabetes, has the incidence rate of end-stage renal disease resulting from diabetic nephropathy increased? As shown in Figure 34-1, in the United States, although the number of persons whose end-stage renal disease (ESRD) was attributed to diabetes (prevalence) has continuously expanded, the incidence rate of new-onset ESRD per 100,000 persons with diabetes has sharply decreased since 1995. This observation was first reported in the Morbidity and Mortality Weekly Report (MMWR) published by the U.S. Centers for Disease Control and Prevention (CDC) in November 2005. Although a rationale for this “good news” was not proposed, the MMWR commented: “Although the number of new cases of ESRD in persons with diabetes increased overall, the incidence of ESRD-DM among persons with diabetes is not increasing among black, Hispanics, men, and persons aged 65–74 years, and is declining among persons aged ,65 years, women, and whites.” Using as denominator all persons known to have diabetes with new incidence of ESRD as numerator revealed a remarkable sharply downward slope from a peak of 305 per 100,000 in 1996 to 232 in 2002 (p ,0.01). Through 2009 the trend continued, indicating that as the total U.S. population continues to increase, the number of people with diabetes also grows; however, the proportion (rate) of individuals with diabetes who will develop ESRD should, by trend analysis, continue to
USRDS: 2006 (age adjusted) Figure 34-1. New-onset end-stage renal disease in persons with diabetes. (From Burrows NR, Wang J, Geiss LS, et al. Incidence of end-stage renal disease among persons with diabetes—United States, 1990–2002. MMWR 2005;54:1097–1100.)
235
CHAPTER 34
DIABETIC NEPHROPATHY Yalemzewd Woredekal, MD, and Eli A. Friedman, MD
Number of new cases of ESRD
50,000
320 Number Rate
300
40,000 280 30,000
260 240
20,000 220 10,000
02
01
20
00
20
99
20
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
19
19
90
200
Per 100,000 persons with diabetes
1. Concurrent with the global pandemic of diabetes, has the incidence rate of end-stage renal disease resulting from diabetic nephropathy increased? As shown in Figure 34-1, in the United States, although the number of persons whose end-stage renal disease (ESRD) was attributed to diabetes (prevalence) has continuously expanded, the incidence rate of new-onset ESRD per 100,000 persons with diabetes has sharply decreased since 1995. This observation was first reported in the Morbidity and Mortality Weekly Report (MMWR) published by the U.S. Centers for Disease Control and Prevention (CDC) in November 2005. Although a rationale for this “good news” was not proposed, the MMWR commented: “Although the number of new cases of ESRD in persons with diabetes increased overall, the incidence of ESRD-DM among persons with diabetes is not increasing among black, Hispanics, men, and persons aged 65–74 years, and is declining among persons aged ,65 years, women, and whites.” Using as denominator all persons known to have diabetes with new incidence of ESRD as numerator revealed a remarkable sharply downward slope from a peak of 305 per 100,000 in 1996 to 232 in 2002 (p ,0.01). Through 2009 the trend continued, indicating that as the total U.S. population continues to increase, the number of people with diabetes also grows; however, the proportion (rate) of individuals with diabetes who will develop ESRD should, by trend analysis, continue to
USRDS: 2006 (age adjusted) Figure 34-1. New-onset end-stage renal disease in persons with diabetes. (From Burrows NR, Wang J, Geiss LS, et al. Incidence of end-stage renal disease among persons with diabetes—United States, 1990–2002. MMWR 2005;54:1097–1100.)
235