In the Literature
Kidney Disease in People With Diabetes: The Expanding Epidemic

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What Does This Important Study Show?

de Boer et al1 analyzed data from NHANES III (Third National Health and Nutrition Examination Survey) conducted in 1988-1994 and the continuous NHANES (1999-2008) to investigate trends in CKD in people with diabetes. This study found that the prevalence of CKD in people with diabetes has increased during the past 2 decades and has done so in proportion to the increasing prevalence of diabetes. This is in contrast to the recent plateau in rates of diabetic end-stage renal disease (ESRD).

The

How Does This Study Compare With Prior Studies?

These results extend previous studies, which also have shown an increasing burden of CKD in the United States.10, 11, 12 Diabetes is a leading cause of CKD, and the prevalence of diagnosed diabetes has increased from 5.1% (NKF-KDOQI3) to 11.9% in the past 20 years in the United States.13 However, the prevalence of undiagnosed diabetes has remained relatively constant during this period.14 Trends in diabetes prevalence reflect the lowering of the diagnostic threshold for fasting glucose level

What Should Clinicians and Researchers Do?

The major message from this study1 is the absolute increase in burden of diabetic kidney disease, which mirrors the increase in diabetes prevalence. These data raise the concern that the plateau in rate of ESRD in people with diabetes may be temporary and may increase as the dual epidemics of obesity and diabetes mature because the lag time from onset of diabetes to ESRD typically is 2 decades or more. Clinicians should optimize treatment of diabetes to prevent the onset of diabetic nephropathy

Acknowledgements

Mr Juraschek was supported by NIH/NHLBI grant T32 HL007024.

Financial Disclosure: Dr Coresh has consulted for Amgen and Merck and has an investigator-initiated grant on CKD prognosis analyses from Amgen. The remaining authors declare that they have no relevant financial interests.

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Originally published online December 12, 2011.

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