Background. The number of individuals initiating renal replacement therapy in the United States population grew exponentially over the past two decades. Cases of end-stage renal diseae (ESRD) attributed to diabetes accounted for most of this increase. In this report we examined factors that may account for the increase to determine whether it truly represents an epidemic of ESRD due to diabetes. Methods. We reviewed time trends in data of the United States Renal Data system, the Diabetes Surveillance Program of the Centers for Disease Control and Prevention, and diabetes literature. Results. Recent growth of the number of individuals with diabetes accounted for less than 10% of the increase in the number of diabetes-related ESRD. Instead, most of it was due to a threefold increase in risk of ESRD in people with diabetes and, therefore, qualifies as an epidemic. Curiously, this epidemic occurred despite widening implementation of effective renoprotective therapies. Individuals with type 2 diabetes, regardless of gender, age, or race, experienced the greatest increase in risk. There is no evidence that diabetic patients have been surviving longer, so the increased risk was not attributable to the high risk associated with long duration diabetes. Conclusion. We hypothesize that an epidemic of ESRD has occurred in people with diabetes in the United States population over the last two decades. The nature of the factor responsible for the epidemic and the reasons it affects patients with type 2 diabetes particularly are unknown. Research efforts to identify the putative factor deserve high priority, as does a commitment of resources to provide care for the burgeoning number of patients with ESRD and type 2 diabetes.
Bibliographical noteFunding Information:
We thank Tom Arnold, Mike Hadad, and Roger Milam of the Health Care Financing Administration for their assistance with the data used for the USRDS projections. Data set construction and data manipulation were provided by Shu-Cheng Chen and Eric Frazier. This work was supported by National Institutes of Health grants DK041526, DK067638, DK058549, and Juvenile Diabetes Research Foundation grant 9-2000-1008.
- ACE inhibitors
- Antihypertensive treatments
- Diabetes mellitus
- End-stage renal disease (ESRD)
- Secular trends