Complications of Diabetic Kidney Disease
Diabetic kidney disease (DKD) is the most common cause of the end-stage renal disease (ESRD). Regardless of intensive treatments with hyperglycemic control, blood pressure control, and the use of renin-angiotensin system blockades, the prevalence of DKD remains high. Recent studies suggest that the spectrum of DKD has been changed and many progresses have been made to develop new treatments for DKD. Therefore, it is time to perform a systemic review on the new developments in the field of DKD.
Over last years, our understanding of DKD has been much improved and new treatments to halt the progression of DKD are coming. However, better diagnostic tools, predictive markers, and treatment options are still urgently needed to help us to better manage these patients with this detrimental disease.
Diabetes affects 30.3 million people of all ages representing 9.4% of US population and about 149 million people and 10.9% of the population in China and 415 million worldwide. DKD is the most common cause of the ESRD in the world, and it is associated with increased morbidity and mortality in diabetic patients. Although the incidence rate of chronic kidney disease (CKD) in diabetic patients has decreased in recent years in the US, the prevalence remains high. In 2018, USRDS annual data reported that diabetes accounted for 36% of CKD in the NHANES population between 2013 and 2016, declining from 44% between 2001 and 2004. However, due to the increased number of diabetic patients, the total number of DKD patients was further increased. The numbers of diabetic adults aged over 18 years who began treatments for ESRD also increased significantly from over 40,000 in 2000 to over 50,000 in 2014. In China, both the incidence and prevalence of DKD have risen dramatically over the last decade. The estimated number of diabetic patients with CKD in China reached 24.3 million. Therefore, DKD is a global public health burden.
High-Risk DKD Patients
DKD is a chronic, progressive disease that develops over time. In the 1970s, the median time to ESRD from the development of overt proteinuria in type I diabetes was 7 years and now is 14 years. The incidence of ESRD in type I diabetes from Finland is now 7.8% at 30 years duration. Much evidence has shown that many patients who are well treated may have relatively stable kidney function or progression at a very slow rate. In 3 recent randomized interventional studies, the rate of decline of eGFR ranged from 0 to 4 mL/min per year. A major factor that may contribute to progression to ESRD in patients with diabetes is acute kidney injury (AKI). Thakar et al. demonstrated that, in a cohort of 4,082 patients with diabetes, single or repetitive episodes of AKI significantly increase the risk of developing advanced CKD. Subsequently, a large prospective study further confirmed that AKI itself can also predict major adverse outcomes including doubling of serum creatinine or ESRD in patients with diabetes.
Journal of Nephrology and Urology is an Open Access peer-reviewed publication that discusses current research and advancements in diagnosis and management of kidney disorders as well as related epidemiology, pathophysiology and molecular genetics.
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Journal of Nephrology and Urology