Thank you statlstics visiting nature. You are using a browser version with limited support for CSS. To obtain the shatistics experience, we recommend you use Importance of hydration more up to date browser or turn off compatibility mode in Internet Explorer.
In the meantime, to ensure continued support, we are nephropzthy the site without styles and JavaScript. A Syatistics to Diabetiic article was published on 29 October Dibetic The kidney is arguably the most important statistlcs of microvascular damage in diabetes.
The presence and severity of Diabdtic kidney disease CKD identify individuals who are at increased risk Lentils and lentil sauce adverse health outcomes nephfopathy premature nephropathhy.
Consequently, preventing and managing CKD in nephrropathy with diabetes is nephropaty a Diabetic nephropathy statistics aim of their overall management.
Intensive management of patients with diabetes includes controlling blood glucose levels and nephropatthy pressure as well as blockade of the renin—angiotensin—aldosterone system; nelhropathy approaches will reduce the incidence of diabetic kidney disease staitstics slow its progression.
Nephropathyy, the major decline in the incidence of diabetic kidney disease DKD over the past 30 years and improved patient prognosis are largely attributable to improved diabetes care. However, there iDabetic an unmet Natural herbal remedies for innovative treatment statisgics to prevent, arrest, treat and reverse DKD.
In this Primer, we summarize what is now Diabwtic about the molecular Fasting and energy levels boost of CKD in patients with diabetes and the key Dianetic and targets implicated in its progression.
In addition, we discuss the current evidence for npehropathy prevention and management of DKD as well as the many controversies. Finally, DDiabetic explore the opportunities Diabetjc develop new interventions through urgently needed investment nephrppathy dedicated and focused research.
Ralph A. DeFronzo, W. Megumi Oshima, Miho Shimizu, … Takashi Wada. Yongjin Yi, Eun-Jeong Kwon, … Sejoong Nelhropathy. Of the long-term complications nephhropathy diabetes, Diabetic nephropathy statistics kidney disease CKD imposes the highest burden both in terms of financial cost and the effects on daily life.
The nehropathy and severity of CKD identify individuals who are at increased risk of adverse statisticx outcomes — including frailty, reduced quality of life, end-stage renal disease ESRD and progressive end-organ damage at other Diabwtic — and premature mortality.
Indeed, excess mortality associated with type 1 diabetes and type 2 diabetes is largely confined to nephdopathy with CKD 1 — Diabetc. Consequently, preventing Diabetic nephropathy statistics managing CKD Diabetic nephropathy statistics patients with nephropathyy is statietics key Electrolytes and energy production of their overall management.
Approximately half of Disbetic patients with type 2 diabetes and one-third with type 1 diabetes statkstics develop CKD, which is clinically defined by the presence of impaired renal function or elevated urinary albumin excretion, or both atatistics6 Box 1.
The percentage of these Diabetic nephropathy statistics who can be considered to have CKD as a result Duabetic their diabetes is unclear. Invariably, other contributors to renal dysfunction are also present, including nephrkpathy, dyslipidaemia, statistiics, intrarenal vascular disease, Diabbetic Herbal brain booster injury, glomerular atherosclerosis, renal Herbal brain booster and ageing-related nephron statistice.
Consequently, it is Djabetic appropriate to identify patients with diabetes and Sfatistics, and to undertake strategies for holistic Diwbetic in patients with diabetes. DKD was originally sttistics by Mogensen 7 Diabetci the s as a progressive disease that Diabwtic with the loss of small amounts of Rowing endurance workouts into the statistixs 30— mg per dayHerbal brain booster as microalbuminuria or occult or nepnropathy nephropathy.
Herbal brain booster presentation was then classically followed by a relentless decline in statiatics function, renal impairment and nephropathj ESRD.
This paradigm has proved useful in clinical studies, especially in type 1 diabetes, statistids identifying cohorts who are at increased risk of Diabrtic health outcomes. However, any boundary between stages is artificial, and the nephropathu between urinary albumin excretion and adverse nephropahty outcomes is log-linear in clinical practice Stress management resources. Moreover, many patients with type 1 statisitcs, and most with type 2 diabetes, nephropatthy not follow this classic nephropaghy in modern clinical practice.
For example, many patients with diabetes nepphropathy renal impairment do not show Rare forms of glycogen storage disease urinary albumin loss 9 Similarly, most patients with Diabegic do not Caffeine pills for alertness and focus a progressive increase Herbal brain booster their urinary Diabeti excretion as in the classic paradigm, and treatment-induced and Diabetic nephropathy statistics remission of albuminuria are commonly observed 10 Although nephrooathy in diabetes management have reduced the proportion of tsatistics with diabetes who develop CKD over any given time period 14 — 16 Diabetlc, their improved prognoses 17 mephropathy, 18 combined with the rising incidence of both type Digestive health detox diets and type Cholesterol level testing methods diabetes 19 have seen the prevalence of CKD continue to grow Prebiotics for optimal nutrient utilization the approximately Diabrtic people with type 2 diabetes worldwide 19approximately nelhropathy will nephorpathy evidence of Nephrppathy The incidence of CKD in type 1 diabetes differs from that observed in type 2 diabetes.
It is estimated that approximately one-third of all people with type 1 diabetes will develop CKD over the course of their lifetime 1522 — This difference is mostly because subjects with type 1 diabetes are generally younger and healthier at diagnosis and carry fewer co-morbid conditions than those with type 2 diabetes.
Consequently, the renal presentation in type 1 diabetes potentially better reflects DKD, rather than the mixed picture of CKD in type 2 diabetes that is confounded by omnipresent other contributors, such as ageing, vascular disease, insulin resistance and obesity.
The incidence, presentation and course of CKD in patients with diabetes vary considerably across countries and settings 21 Fig. Disadvantaged and minority populations also have a high prevalence of CKD and its subsequent progression.
For example, the prevalence of albuminuria is nearly twice as common in Indigenous Australians in primary care compared with non-Indigenous Australian patients presenting to the same clinical practice The reasons for ethnic differences in CKD are complex 27 and include economic, social or educational disadvantage, access to and uptake of care, lower achievement of treatment goals, lower screening rates, suboptimal early treatment of complications, diet and lifestyle factors, smoking, obesity, genetic factors and developmental programming.
Another important feature is the younger age of onset of type 2 diabetes in these at-risk groups, which might be associated with a more malignant course, including accelerated β-cell loss in the pancreas, as well as renal and cardiovascular complications Data from patients with type 2 diabetes surveyed in the US NHANES III 4the Australian NEFRON study 5the Italian RIACE study 86and the DEMAND study Blue circles denote patients with albuminuria.
The percentage not included in either circle denotes patients without chronic kidney disease CKD. PowerPoint slide. This variability partly relates to the competing risk of premature mortality, chiefly owing to cardiovascular disease.
Many and probably most patients with CKD will die before they develop ESRD 1317 Moreover, as most patients with diabetes now reside in developing countries 19the few that develop ESRD will seldom be able to access renal replacement therapy RRT programmes. However, the unparalleled number of patients with diabetes makes this disease the leading single cause of ESRD.
In many countries, such as the United States, diabetes is present in more than half of all patients entering RRT programmes One ore more of the following criteria must be present for more than 3 months and validated by repeat testing before a clinical diagnosis of chronic kidney disease CKD can be made:.
DKD has been traditionally viewed as a microvascular disorder, clustered along with retinopathy and neuropathy, and separate from macrovascular disease that contributes to coronary heart disease, peripheral vascular disease and cerebrovascular disease.
However, each disorder can be considered to be a tissue-specific manifestation of the same pathogenetic process, and DKD is the renal manifestation of the same glucose-driven process that occurs at susceptible sites elsewhere in the body 31 — Although all cells are chronically exposed to high plasma glucose levels in patients with diabetes, only some show progressive dysfunction, of which the endothelial cells lining the vasculature are a prime example.
Specifically, the inability of endothelial cells to downregulate their glucose transport in response to high glucose levels 35 leads to an overwhelming flux of intracellular glucose, which triggers the generation of pathogenetic mediators that contribute to the development of diabetic complications, including DKD.
Excessive glucose flux leads to the generation of toxic intermediates, the most important of which are thought to be reactive oxygen species ROS. Excessive glucose flux can generate ROS in several different ways. Enhanced mitochondrial substrate oxidation with consequent enhanced mitochondrial membrane potential leads to the overproduction of superoxide.
At the same time, increased glucose flux leads to the activation of NADPH oxidase and uncoupling of nitric oxide synthase ROS-mediated DNA strand breaks in the nucleus activate DNA repair mechanisms, including the enzyme poly ADP ribose polymerase 1 PARP1which inhibits the key glycolytic enzyme glyceraldehydephosphate dehydrogenase GAPDH by polyADP-ribosylation.
Inhibition of GAPDH activity causes a bottleneck in glycolysis, resulting in the upstream accumulation of early glycolytic intermediates that are increasingly diverted into activating pathogenetic signalling pathways 3738 Fig. Together, these diversions lead to cellular dysfunction, inflammation, apoptosis and fibrosis in cells exposed to excessive glucose flux.
The central importance of ROS in initiating each of these processes is illustrated by the fact that each can be prevented when hyperglycaemia-mediated ROS generation is curtailed Mitochondrial production of reactive oxygen species ROS accelerates in response to an increase in intracellular glucose.
In addition, pathogenetic ROS are also generated through the ROS-induced uncoupling of nitric oxide synthase eNOS and inactivation of NADPH oxidases. ROS can mediate DNA damage, which in turn activates poly ADP ribose polymerase PARP.
PolyADP-ribosylation of glyceraldehydedehydrogenase GAPDH by PARP leads to the inhibition of this key glycolytic enzyme and a subsequent bottleneck in glycolysis.
As a result, early glycolytic intermediates accumulate and are then diverted into pathogenetic signalling pathways. AGE, advanced glycation end-product; DAG, diacylglycerol; DHAP, dihydroxyacetone phosphate; GFAT, glutamine fructosephosphate amidotransferase; NF-κB, nuclear factor-κB; PKC, protein kinase C; RAGE, receptor for AGE; UDP-GLcNAc, uridine diphosphate N-acetylglucosamine.
Each cell has pathways that recognize and specifically respond to nutrient abundance to ensure efficient substrate use.
In addition, podocyte-specific activation of mTOR recapitulates many features of DKD, including mesangial expansion and proteinuria 40 These findings have led to the concept of directed interventions to simulate energy depletion associated with increased activity of AMPK and sirtuins and reduced mTOR activity and promote efficient cellular function.
Experimental data seem to support this strategy for renoprotection 39 — 42and agents such as metformin, peroxisome proliferator-activated receptor PPAR agonists 3738phosphodiesterase inhibitors and resveratrol act on these pathways. Only one-third of patients with type 1 diabetes will develop overt nephropathy 1522 — 24whereas almost all patients with type 1 diabetes eventually develop some degree of retinopathy.
This suggests that additional risk factors beyond hyperglycaemia must also be involved in DKD. Indeed, although hyperglycaemia is an essential requirement for DKD, it is seldom the only contributor. Pathogenetic pathways initiated and sustained in the kidney by elevated glucose levels can be enhanced by several different factors.
These include a range of metabolic factors, including excess fatty acids, carbonyl and oxidative stress, as well as haemodynamic factors, including shear stress induced by transmitted systemic hypertension, impaired autoregulation, hyperperfusion and hypoperfusion, and activation of the renin—angiotensin—aldosterone system RAAS On their own, these factors do not cause DKD but rather, in the presence of diabetes, feed into and enhance common pathogenetic mechanisms that include increased levels of growth factors, vasoactive hormones, cytokines and chemokines in the kidney.
For example, glucose-induced endothelial dysfunction increases vascular susceptibility to shear stress, oxidative stress and other stressors. Endothelial dysfunction and subsequent microvascular rarefaction induced by hyperglycaemia also reduce blood flow while oxygen consumption is increased, leading to hypoxia.
In turn, renal hypoxia induces compensatory — but ultimately maladaptive — changes in blood flow, metabolism and polar vasculosis glomerular neoangiogenesis 44 — Despite the importance of the vascular endothelium in microvascular complications, many investigators propose that the early changes in renal glomeruli are critical for the subsequent development of glomerulosclerosis and nephron dropout Fig.
Among these changes, the most important might be dysfunction of glomerular podocytes, which are highly specialized terminally differentiated cells that cover the urinary side of the glomerular basement membrane GBM Together with glomerular endothelial cells, podocytes are responsible for the maintenance of the GBM, its charge barrier and the shape and integrity of the glomerular capillary loop; all functions that are compromised in the diabetic glomerulus.
Experimental models demonstrate that podocyte-specific injury can recapitulate a diabetes-like phenotype of glomerulosclerosis and tubulointerstitial fibrosis, even in the absence of hyperglycaemia Moreover, protecting podocytes from hyperglycaemia with a podocyte-specific deletion of the glucose transporter solute carrier family 2, facilitated glucose transporter member 4 SLC2A4; also known as GLUT4 51 or from the resulting oxidative stress 52 can prevent diabetes-associated albuminuria without restoring normal levels of glucose.
Such data place podocytes, and more particularly the dysregulation of their growth and differentiation, at the very centre of the pathogenesis of DKD.
Some studies suggest that a reduction in podocyte density might be a useful predictor for DKD and its progression 53 Morphological and functional alterations to renal glomeruli are one of the hallmarks of diabetic kidney disease.
GBM, glomerular basement membrane. One of the earliest and most characteristic of all glomerular changes in diabetes is a homogenous thickening of the GBM 53 Thickening of the GBM is present in almost all patients with diabetes within a few years of diagnosis, although more pronounced changes are observed in DKD Whether GBM thickening is a marker of podocyte or endothelial dysfunction or a mediator of progressive DKD is unclear.
Certainly, changes in the composition, charge or architecture of the GBM associated with thickening could contribute to albuminuria. Stiffening of the GBM might also reduce distensibility of the pericapillary wall and compromise the subpodocyte space, facilitating glomerular injury through haemodynamic mechanisms
: Diabetic nephropathy statistics| What is diabetes? | Article CAS PubMed PubMed Central Google Scholar NCD Risk Factor Collaboration NCD-RisC. Similarly, intensification of glucose control in patients with diabetes and CKD can be problematic as the multiple agents and high doses that are often required exposes patients to an increased risk of adverse drug reactions. Hypertension prevalence was significantly higher among microalbuminuria, macroalbuminuria and ESRD patients, accounting for If damage is severe, the kidneys can eventually lose the ability to filter out waste products from the bloodstream, resulting in a person needing dialysis or a kidney transplant in order to stay alive. And dbPKD is free for non-commercial activities. The age-standardized DALY rate ranged from 7. Yuan, C. |
| Diabetic kidney disease | Nature Reviews Disease Primers | However, in older people with type 2 diabetes, whose kidneys may already have been damaged by high blood pressure or cardiovascular disease, diabetes appears to cause progressive kidney damage much sooner. Therefore, it is important that your doctor monitors your kidney health and that you try to look after your kidneys. Dialysis and kidney transplantation can be used to treat kidney failure caused by diabetes, but potential problems can occur because diabetes can affect so many other organs, and large arteries. Some people may also consider having a pancreas transplant to maintain better diabetic control. But this is a bigger operation and carries more risks than a kidney transplant. Pancreas islet cell transplantation is an alternative that is suitable for some people. If you have diabetes, your doctor should be monitoring your kidney health. This is normally done at least annually, with a blood and urine test to check how well your kidneys are working. You can also watch GP Dr Kathryn Griffith who specialises in kidney health explain the link between diabetes and kidney disease. If you have any queries or concerns, talk to your diabetes care team, who should be able to answer most of your questions. We hope that this will lead to future work to investigate treatments in type 2 diabetes which could prevent kidney damage. Researchers at the University of Bristol discovered a protein that may play a crucial role in the development of kidney disease in people with type 2 diabetes. With the help of funding from Kidney Research UK and the Medical Research Council, the team identified a potential way to stop people with type 2 diabetes from developing diabetic kidney disease: the most common cause of end-stage kidney failure worldwide. Our research is helping to change lives for people living with kidney disease. What is diabetes? Types of diabetes. There are two main types of diabetes: Type 1 diabetes — where the body's immune system attacks and destroys the cells that produce insulin. About 10 per cent of people with diabetes in the UK have Type 1 diabetes and need regular insulin injections to stay alive. It often begins in childhood or adolescence and is not caused by dietary or lifestyle factors. Type 2 diabetes — where the body doesn't produce enough insulin, or the body's cells become resistant to insulin. This is by far the most common type of diabetes. The main risk factors for type 2 diabetes are: Being overweight or obese Sedentary lifestyle lack of regular aerobic exercise Having a family history of type 2 diabetes Being from a minority ethnic group Older age — although type 2 diabetes is now increasingly common in younger people with obesity. How does diabetes affect the kidneys? Diabetes risk factors. Some things are known to increase the risk of getting diabetic kidney disease: Poor blood glucose control High blood pressure A family history of kidney disease or high blood pressure Smoking Developing diabetes in your teens Being overweight or obese Being male Being of Afro-Caribbean or South Asian descent. Other potential complications of diabetes. High blood pressure: This is usually an early sign of diabetic kidney disease. Arterial damage: Large blood vessels e. arteries can be damaged by diabetes, leading to a greater risk of heart attacks, strokes and cardiovascular problems — especially if high cholesterol and high blood pressure is also an issue. Eye damage: Damage to smaller blood vessels can affect the retina at the back of the eye and cause bleeding and possible vision loss. Nerve damage: This can cause numbness and tingling, especially in the feet. Diabetes treatment. People can reduce their risk of developing diabetic complications by: Giving up smoking — to benefit the kidneys, as well as the cardiovascular system and general health. Reducing blood pressure by taking regular exercise, losing weight, keeping alcohol intake down, eating a good healthy diet, reducing salt intake and controlling cholesterol. Some people may also need to take tablets to control blood pressure. People who already have early signs of diabetic kidney disease can benefit from drugs called ACE inhibitors or ARBs. Controlling glucose levels with the help of tablets, insulin and a healthy diet. Some new treatments that were designed to help control blood glucose appear to reduce the risk of developing or worsening diabetic kidney disease, over and above their effect on blood glucose. Treatments for kidney failure Dialysis and kidney transplantation can be used to treat kidney failure caused by diabetes, but potential problems can occur because diabetes can affect so many other organs, and large arteries. Resources about diabetes. Further information is available from: Diabetes UK The National Kidney Federation The Edinburgh Renal Unit You can also watch GP Dr Kathryn Griffith who specialises in kidney health explain the link between diabetes and kidney disease. Researcher spotlight Researchers at the University of Bristol discovered a protein that may play a crucial role in the development of kidney disease in people with type 2 diabetes. Read about the research. Comparisons of the proportions of patients with diabetes who develop ESRD are needed to better understand the diabetes-related renal failure. We hypothesize that these proportions varied substantially across the geographic regions and that a nonrandom variation implied a fundamental difference in factors such as appropriateness of disease care, environmental risk exposure, and genetic susceptibility. A better understanding of the relative global importance of diabetes in ESRD pathogenesis may also advance our knowledge about the underlying mechanisms, enable the more efficient allocation of limited health care resources, and allow the development of better prevention and treatment strategies. Five parameters are required to calculate the incidence of ESRD among patients with diabetes i. The number of incident ESRD patients with diabetes was calculated as the number of incident ESRD patients multiplied by the percentage of incident ESRD patients with diabetes. The number of prevalent ESRD patients with diabetes was calculated as the number of prevalent ESRD patients multiplied by the percentage of prevalent ESRD patients with diabetes. The resulting values were converted to counts per million population pmp for comparability among countries. Both type 1 and type 2 diabetes were included in this study. Linear regression models based on the data from to were used to estimate the data in The other four parameters were acquired from regional Europe and Latin America and national renal registries and from reliable literature. All renal registries, reviews, book chapters, clinical or epidemiological studies on kidney diseases or ESRD, and news articles by journalists were eligible for data extraction. The reported data were defined as those extracted from regional or national renal registries or from peer-reviewed journal articles or book chapters. The following methods were used for estimation of data for countries that did not report ESRD prevalence or incidence. First, we estimated the prevalence or incidence by the reported values of other years using either a linear regression or exponential curve model if multiple data points were available. The model type was selected based on face validity no negative values or extreme values , R 2 values, incidence or prevalence trend, and trends in neighboring countries. If the year s to be estimated were surrounded by years with available data, at least four data points were included into the model whenever possible. Otherwise, at least six data points were included whenever possible. The estimates were based on years close to the targeted years. Second, if incidence data were available in the literature or by estimation and only one prevalence data point was available, the prevalence in other years was estimated according to the incidence trend. This was supported by an observed linear correlation between reported prevalence and incidence data see Supplementary Material for European countries, U. Third, if no incidence data and only one prevalence data point were available, the prevalence in other years was estimated according to the trend of an adjacent or nearby country in the same region. Selection of the index country was based on the following criteria in the specified order: geographic proximity, availability of reliable data from renal registry, literature, or news articles, in this order , comparability of economic status such as gross national income per capita , and similarity of nephrology care e. The same rules were applied to estimate the incidence from the reported prevalence. Nearly all sub-Saharan African countries had no data of ESRD incidence available. It is defined as the percentage of ESRD patients who required but did not receive RRT. The percentage of prevalent ESRD patients with diabetes was defined as the percentage of prevalent ESRD patients diagnosed with diabetes before or after entry to ESRD. The percentage of incident ESRD patients with diabetes was defined as the percentage of incident ESRD patients diagnosed with diabetes before reaching ESRD. If the percentage data for ESRD patients were not available in any way, we adopted the frequency of diabetes among patients with chronic kidney disease CKD , using the stage as late as possible, as a less stringent but close estimate of the percentage of diabetes among incident ESRD patients. These estimates might have been less than the true proportion of incident ESRD patients with diabetes because CKD patients with diabetes are more likely to progress to ESRD. First, they were estimated from a linear regression or exponential curve model established with use of available data points if more than two were available. Fourth, the percentage of prevalent ESRD patients with diabetes directly adopted the percentage of incident patients, or vice versa, if no reliable reference data from another country were available. Fifth, the percentage adopted the data directly from an adjacent country if no reported data were available. We retrieved the literature that reported the data of the proportion of patients with diabetes who progress to ESRD. We also compared the estimates of the ESRD prevalence with the data in , , and provided by Fresenius Medical Care, Germany. We used SPSS, version 18 Chicago, IL , and the built-in statistical tools in Microsoft Excel to perform the linear regression model, the exponential curve fitting, and statistical analyses including calculation of the R 2 of the models, the Pearson correlation coefficient, and one-way ANOVA and the Scheffe post hoc analysis. We obtained data from countries as indicated in Supplementary Table 1 and completed tabulation for countries in the years , , , , , , and These data represented The reported data revealed a strong correlation between the ESRD prevalence and incidence as well as between the percentage of prevalent ESRD in patients with diabetes and of incident ESRD in patients caused by diabetes Supplementary Tables 2 and 3. These findings supported the estimation of either the prevalence or incidence, or either percentages, from its counterpart if data were lacking for one parameter. The global percentage of prevalent ESRD patients with diabetes increased from However, significant variation was observed among geographic regions Supplementary Table 5. The most rapid increase rates occurred in the Western Pacific and Eastern Mediterranean Regions Table 1 and Supplementary Table 6. In contrast, the slowest increases were observed in Europe, where Within any given year, the percentages of prevalent ESRD patients with diabetes did not differ statistically across the four income groups Supplementary Table 5. This percentage increased at a significantly slower rate in high-income countries relative to upper-middle-income and lower-middle-income countries Supplementary Table 7. Percentage of prevalent ESRD patients or incident ESRD patients with diabetes worldwide from years to The yearly change rate is the slope calculated by linear regression model. The percentage of incident ESRD patients due to diabetes increased steadily worldwide, from Increasing trends were observed in most countries Countries in these regions had already reported high percentages of incident diabetes-related ESRD in the early s and much more rapid increases relative to other countries Supplementary Table 9. Both African and European countries had the lowest percentages of incident ESRD patients caused by diabetes in the early s and reported slower rates of increase over time Supplementary Table Consequently, the percentages in these regions remained the lowest throughout the study period. Furthermore, the income level had a differential effect on the percentages each year, and this difference was most pronounced between high- and low-income countries Table 1 and Supplementary Table 5 , with increasing trends observed in The ESRD incidence data in three African countries, namely, Algeria, South Africa, and Zimbabwe, were derived from patients receiving treatment, and the African region that included only these three countries had the lowest incidence over time. For the rest of 34 WHO-defined African countries and Somalia defined as an Eastern Mediterranean country , the ESRD incidence rates were derived from patients requiring RRT. As a result, the African Region, the low-income group, and the lower-middle-income group posted substantially higher ESRD incidence than all other countries Table 2 , Supplementary Table 11 , and Supplementary Fig. A dramatic increase in the ESRD incidence was observed in Southeast Asia during the study period Taiwan, Thailand, and Nepal were among the highest , leading to the second highest nearly the highest incidence of ESRD in Table 2. The yearly change rate was the slope calculated by linear regression model. Data excluding the countries whose ESRD incidence rates were estimated by the number of new patients in need of RRT instead of those being treated. Between and , the global annual incidence of ESRD among patients with diabetes increased from This incidence was modest in the European Region, ranging from approximately half of that in the Western Pacific Region in to one-third in The Western Pacific Region and Europe also exhibited the fastest and slowest annual increases in the ESRD incidence among patients with diabetes, respectively; the latter was significantly slower than the global rate of change. From to , the highest average annual rate of increase was observed in the Western Pacific Region. The incidence of ESRD among patients with diabetes was remarkably high in the low-income and lower-middle-income countries, which also reported high annual rates of increase in this incidence. A sensitivity analysis, which included only the three African countries Algeria, South African, and Zimbabwe whose estimation of the ESRD incidence was based on new patients under treatment, instead revealed the lowest incidence of diabetes-related ESRD in the African Region Table 3. This incidence was similar among all four income groups over time Table 3 and Supplementary Table 5. However, a significantly slower annual rate of increase in this incidence was observed in the low-income group relative to the other groups Table 3 and Supplementary Table Similarly, the annual rate of increase in this incidence in the Eastern Mediterranean Region slowed considerably when Somalia was not included Table 3 and Supplementary Table Annual incidence of ESRD among patients with diabetes worldwide and by the WHO regions or the World Bank income groups from years to The numbers are people per million patients with diabetes. The yearly change rate was the slope of annual rate against year calculated by the linear regression model. The annual incidence of ESRD among patients with diabetes in and , in people pmp. The inset maps show the results. ND, no data. The incidence of ESRD from the population with diabetes was reported from 19 countries or territories during — Supplementary Table Twenty-eight data points were comparable plus 16 studies focusing on type 1 diabetes or special subgroups. From to , the global ESRD prevalence doubled from In , 72 of 85 countries Similar patterns were observed for the differences in counts or percentages in the data from and Supplementary Figs. In , based on the model, 40 of 44 countries Moreover, the estimates of ESRD prevalence in 31 countries This study yielded three major findings. First, the proportion of prevalent ESRD patients with diabetes continued to rise worldwide. The slowest annual increase in this proportion was observed in Europe, but nearly threefold increase was reported in the Eastern Mediterranean and Western Pacific regions. Second, the importance of diabetes as a risk factor for ESRD was observed both in high-income countries and in increasing numbers of developing and underdeveloped countries. Third, substantial geographic variation was observed in the incidence of ESRD among patients with diabetes. Remarkably, the incidence in Western Pacific countries was twice the world average and thrice that of the lowest incidence observed in Europe. Our findings reveal that the expansion of populations with diabetes among the ESRD patients is a global phenomenon, and it does not appear to be stoppable anytime soon. Special consideration should be given to the challenges of providing care to an ESRD population with a higher proportion of patients with preexisting diabetes. We should appreciate the fact that diabetes is becoming the dominant risk factor for ESRD in developing and underdeveloped countries—not just as seen in the developed countries. Interestingly, decrease of the percentage of incident ESRD patients due to diabetes was seen in five European countries and three African countries Table 1 , even though their diabetes prevalence kept increasing as in all other countries. Risk stratification based on geographic origins may be needed to identify populations with diabetes that should be targeted more aggressively to prevent the initiation of renal complications or halt further deterioration. Our survey for the incidence of ESRD among populations with diabetes with a global perspective may help disclose a mechanism in determining the progression of diabetic kidney disease. The international variation was enormous, yet the pattern was nonrandom. One potential explanation is the competing risks between death and kidney failure in patients with diabetes Our equation included only patients treated with RRT and did not consider those who died of cardiovascular or renal complications before reaching ESRD. This incidence may be deceptively lower in countries where a higher proportion of patients with diabetes died before reaching ESRD due to lack of appropriate care or delayed initiation of RRT or soon after reaching ESRD due to lack of RRT or voluntary choice of conservative treatment. Proper care including blood pressure control, blockade of renin-angiotensin system, awareness of CKD itself, and timely referral to a nephrologist can halt the progression of diabetic kidney disease, but they were inadequate in many underdeveloped countries As the aging population is more vulnerable to the progression to ESRD, the developed countries with a higher proportion of older patients with diabetes should have more patients with diabetes entering ESRD. However, our analysis of data from countries in Western Europe versus those in industrialized area of Asia Japan, Taiwan, South Korea basically excluded the possible effects of age, sex, and RRT access. Tobacco smoking is known to increase the risks of mortality and vascular complications in patients with diabetes This small discrepancy is far less than the fold difference in the annual rate of incident ESRD among patients with diabetes between these countries. The effects of climate 26 or air pollution 27 are said to be important but inconclusive. The existence of an unknown protective environmental factor is supported by the finding that the annual incidence of ESRD among patients with diabetes in Northwestern Europe Denmark, Finland, Iceland, Norway, Sweden, U. ranged from to pmp in compared with 1, pmp among people in the U. Food choice such as high meat intake is another risk factor for the progression of diabetes complications Interestingly, Fuller and Rowlands proposed a long-lasting difference in food selection and preparation between eastern and western Asia since BC: grinding, roasting, and bread baking in western Eurasia, including the Mediterranean region, versus whole grain boiling and steaming in China and the Far East Asian people with diabetes have a greater risk of developing related complications than their counterparts in Western countries; consequently, the former population also faces higher risks of all-cause and cause-specific mortality 30 , Data from the USRDS indicated that from to , the age- and sex-adjusted incidence of ESRD due to diabetes was 3. A longitudinal observational study of 62, patients with diabetes conducted at Kaiser Permanente of Northern California reported adjusted hazard ratios for ESRD of 2. In a sample of patients with diabetes with advanced CKD estimated glomerular filtration rate of We used two approaches to validate our model. First, we compared our data regarding the annual incidence of ESRD among patients with diabetes with data from a limited number of literature reports. The data in the latter sources were generally higher because the study populations had been carefully followed and all recruited case subjects reached ESRD. In contrast, our model had a larger denominator because it included the entire population at risk i. Second, we compared the ESRD prevalence in this study with the data provided by Fresenius Medical Care and determined a high level of similarity, with few exceptions. Accordingly, the Fresenius data set is validated as an accurate reference. Furthermore, the similarities between our estimates and the Fresenius data vindicate the model-building concept in our study in terms of estimating the global ESRD prevalence. Only six countries, namely, India, Myanmar, Sri Lanka, China, Vietnam, and Bangladesh, showed a twofold difference between the reported or estimated ESRD prevalence and the Fresenius data. For the first three countries and Yemen , we estimated the prevalence of ESRD patients requiring RRT, which was the prevalence of treated ESRD multiplied by a ratio between the ESRD patients who required RRT and those who received it. Apparently, this correction made the estimates remarkably high. Take India, for example. The sample to report the prevalence in China was presumably overrepresenting because the subjects were urban residents and insured The ESRD prevalence for Vietnam was derived from the total number of dialysis patients and, hence, supposed to be more accurate than the Fresenius data. The data of ESRD prevalence in Bangladesh were obtained from the USRDS and were considered authorized. This study had a few limitations. First, even in a patient with diabetes, ESRD may or may not be caused by diabetic nephropathy; diabetes might simply be a comorbidity with ESRD The annual incidence of diabetes-related ESRD may have been overestimated. Second, the incidence of ESRD mostly described treated ESRD patients instead of the entire population who had reached ESRD, regardless of the RRT status. Accordingly, the calculated annual incidence of ESRD among patients with diabetes would have been considerably underestimated. Third, our model equation was based on the number of patients with prevalent diabetes, who had diabetes for various periods of time. |
| Diabetic kidney disease | Diabetes risk factors. Some things are known to increase the risk of getting diabetic kidney disease: Poor blood glucose control High blood pressure A family history of kidney disease or high blood pressure Smoking Developing diabetes in your teens Being overweight or obese Being male Being of Afro-Caribbean or South Asian descent. Other potential complications of diabetes. High blood pressure: This is usually an early sign of diabetic kidney disease. Arterial damage: Large blood vessels e. arteries can be damaged by diabetes, leading to a greater risk of heart attacks, strokes and cardiovascular problems — especially if high cholesterol and high blood pressure is also an issue. Eye damage: Damage to smaller blood vessels can affect the retina at the back of the eye and cause bleeding and possible vision loss. Nerve damage: This can cause numbness and tingling, especially in the feet. Diabetes treatment. People can reduce their risk of developing diabetic complications by: Giving up smoking — to benefit the kidneys, as well as the cardiovascular system and general health. Reducing blood pressure by taking regular exercise, losing weight, keeping alcohol intake down, eating a good healthy diet, reducing salt intake and controlling cholesterol. Some people may also need to take tablets to control blood pressure. People who already have early signs of diabetic kidney disease can benefit from drugs called ACE inhibitors or ARBs. Controlling glucose levels with the help of tablets, insulin and a healthy diet. Some new treatments that were designed to help control blood glucose appear to reduce the risk of developing or worsening diabetic kidney disease, over and above their effect on blood glucose. Treatments for kidney failure Dialysis and kidney transplantation can be used to treat kidney failure caused by diabetes, but potential problems can occur because diabetes can affect so many other organs, and large arteries. Resources about diabetes. Further information is available from: Diabetes UK The National Kidney Federation The Edinburgh Renal Unit You can also watch GP Dr Kathryn Griffith who specialises in kidney health explain the link between diabetes and kidney disease. Researcher spotlight Researchers at the University of Bristol discovered a protein that may play a crucial role in the development of kidney disease in people with type 2 diabetes. Read about the research. Our diabetes research Our research is helping to change lives for people living with kidney disease. Diabetes and kidney research charities team up to tackle diabetic kidney disease 14 February Identifying a new drug target for diabetic kidney disease 6 February Finding new ways to treat diabetic kidney disease 22 January Finding the best way to prevent kidney failure in diabetic kidney disease 15 January Tackling multiple health conditions for holistic wellbeing 13 December Do chemical changes to kidney DNA cause diabetic kidney disease? New Wales project for underserved communities launches on World Diabetes Day 14 November New screening programme in Wales 13 April Protecting kidney function in diabetic kidney disease 8 February Investigating a novel treatment for nephrotic syndrome and diabetic nephropathy 11 July Identifying who will develop diabetes after kidney transplant 9 June New study to investigate whether changes in gut bacteria can cause kidney disease in people with diabetes 9 May Scientists discover potential target for treatment of diabetic kidney disease 13 May Worried about your kidneys? Take our free online kidney health check today. Our life-saving research is only possible with your support. Donate today and help transform lives. Donate now. This website uses cookies to improve your experience. We use cookies to offer you a better browsing experience and analyse site traffic. Close Privacy Overview This website uses cookies to improve your experience while you navigate through the website. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are as essential for the working of basic functionalities of the website. The highest frequency was seen among the 45 to 64 age group in the total sample Males had higher frequency in the total sample or nephropathic patients, regardless of the nephropathy types, but the highest in macroalbuminuria and ESRD, with a percentage of When comparing the marital status of nephropathic patients with their non nephropathic counterparts, there was a significantly lower percentage of singles, but a higher percentage of widows among nephropathic patients 2. Smoking was significantly more prevalent among nephropathy patients in general, at This was the same for ESRD patients, where Prevalence of neuropathy was significantly higher in nephropathic patients as a whole, accounting for Retinopathy prevalence was significantly higher among nephropathic patients Vasculopathy as ischemic heart disease, cerebrovascular disease or periphrovascular disease was found in Hypertension prevalence was significantly higher among microalbuminuria, macroalbuminuria and ESRD patients, accounting for Hyperlipidemia prevalence was This was true for macroalbuminuria, and ESRD Figure 2 shows the correlation between patients' age groups and diabetes duration in relation to the prevalence of diabetic nephropathy. The prevalence of nephropathy multiplied with increase in age and diabetes duration. Nephropathy prevalence calculated per group according to age in relation to the five years duration for the total of 54, patients. Figure 3 is the forest plot for odds ratio OR and relative RR risk for diabetic nephropathy risk factors in the studied sample. Table 3 demonstrates OR and RR for risk factors related to the different types of diabetic nephropathy. Retinopathy and neuropathy had OR of 1. Obesity had a significant OR of 1. The study sample used in this study represents the known age and gender distribution seen in Saudi society [5]. The overall prevalence of diabetic nephropathy among type 2 diabetic patients older than 25 years in the SNDR was A similar cohort of type 2 diabetic patients reported by Mohan et al. These findings are less than expected, as proven by different studies from the United States and India in the years and , where microalbuminuria and macroalbuminuria were reported to be This is true in the Saudi cross sectional hospital based study, where microalbuminuria was reported to be The low percentage of microalbuminuria and macroalbuminuria reported by SNDR patients resulted from a lack of screening programs in most health institutions, which is not the case in ESRD cases that do not need screening, but usually discovered because of the acute presentation and clinical symptoms. Saudi men with type 2 diabetes have a higher prevalence of diabetes nephropathy, as has been observed by similar studies in different communities [16] , [17]. This may be explained by the fact that the estrogen hormone plays an important role in protection [18]. In this study, men have a higher risk of ESRD, which differs from what has been found by the Denmark and Korean studies. This may be explained by the lower number of male patients [16] , [19]. The prevalence of ESRD in this cohort is three times that reported by the Thailand Diabetes Registry, where it was 0. This may be explained by the high percentage of poor glycemic control, retinopathy and hypertension, in addition to the longer duration of diabetes among the SNDR cohort. This study reports on the age effects of both microalbuminuria and macroalbuminuria, which are similar to the CURES study in India [14]. In comparing this registry with similar registries, BMI was found to be higher among Saudi diabetic nephropathy patients than has been reported in Danish people [16] , due to the high prevalence of obesity and being overweight among the Saudi population [20]. There is a strong correlation between age and diabetes duration, as seen in other published data [14] , [21]. This was the same finding in different ethnic groups, as shown in Korean, Indian and Taiwanese studies [19] , [21] , [6]. In the Saudi population, the hazard ratio for diabetes nephropathy was found to be 2. The role of diabetes duration has been proven by the UKPDS, where approximately one quarter of patients, developed microalbuminuria or worsening nephropathy after ten years [22]. Diabetic retinopathy is a known risk factor for diabetic nephropathy in different ethnic populations, as reported in Taiwanese and Danish studies [6] , [16]. Since diabetic neuropathy has been found by the UKPDS to be a risk factor for renal insufficiency or mircoalbuminuria and macrolbuminuria [23] , this study move in the same direction, proving that neuropathy has a higher OR and RR. Hypertension presents a significant risk for nephropathy in general, and with each type of diabetic nephropathy, which was also observed by another Saudi study [11]. Age alone has been found to be an important risk factor, which is the same observation in this study, but not for microalbuminuria patients [16] , [17]. The RENAAL study showed that dyslipidemia was associated with greater hazards in the development of a renal end point [24] , and high cholesterol, LDL and triglyceride has been proven to be a risk for diabetic nephropathy by many studies [17] , [23]. This is also true in this study, with significantly increased OR and RR when looking at hyperlipidemic patients, but was not significant for ESRD cases. Male gender is a known risk factor in many studies, which is true in this study but not for microalbuminuric subjects, which could be explained by underestimation due to underscreening [16] , [17]. This study has a lower OR and RR for smoking than reported by other studies [17] , [19] , [25] due to low smoking prevalence among Saudi women [26]. The role of strict control on the progression of diabetic nephropathy is not firmly established [27] , although poor glycemic control is a recognized cause of diabetic nephropathy [6] , [27] , [28]. In agreement with a number of previous studies, we also demonstrate that poor glycemic control is associated with diabetic nephropathy [29]. We have identified being overweight or obesity as a strong and potentially modifiable risk factor for the development of ESRD, which was the same observation as seen in other studies [30]. Our observation shows that Obesity seems to be an important -and potentially preventable- risk factor for ESRD that may be explained by weight loss among case patients, as a consequence of morbidity related to renal failure itself, as also seen by another study [31]. In conclusion, diabetic nephropathy is underestimated in the SNDR as being due to lack of screening programs, an observation that is shared by other registries. ESRD risk factors are the same except for hyperlipidemia and poor glycemic control. There is an urgent need to launch a screening program for diabetic nephropathy, and to start prevention to protect the kidney in diabetic patients. The authors would like to thank King Faisal Hospital and Research Center for their active contribution to the design and development of the web-application and for providing user and technical support for the registry. We also acknowledge the considerable support of Al-Elm information technology in the process of data ascertainment. Moreover, we acknowledge the registry staff for their effort in data management. Conceived and designed the experiments: KAR AMY SNS. Performed the experiments: SKD DA. Analyzed the data: NAA AHA. Wrote the paper: KAR AMY HMA. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Reader Comments Figures. Abstract Aims The prevalence of diabetic nephropathy and its risk factors have not been studied in a society known to have diabetes epidemic like Saudi Arabia. Results The overall prevalence of diabetic nephropathy was Conclusion The prevalence of diabetic nephropathy is underestimated as a result of a shortage of screening programs. Lucrecia Alvarez, TGen, United States of America Received: October 20, ; Accepted: January 16, ; Published: February 21, Copyright: © Al-Rubeaan et al. Introduction Electronic medical health systems have made chronic diseases like diabetes mellitus easier to monitor and understand through large data base registries. Methodology SNDR, hosting more than Download: PPT. Figure 1. Statistical Analysis All data were entered into the centralized database via the web application SNDR, and was analyzed using SPSS program version Results A total of 5, patients fulfilled the diabetic nephropathy criteria from the selected sample, accounting for Table 1. Descriptive analysis of the selected cohort according to the Nephropathy type. Table 2. Frequency analysis of the selected cohort according to the Nephropathy type. Figure 2. Three dimensional figure for prevalence of diabetic nephropathy according to age and diabetes duration grouping. Figure 3. Table 3. Multiple logistic regression analysis of risk factors for different type of nephropathy. Discussion The study sample used in this study represents the known age and gender distribution seen in Saudi society [5]. Acknowledgments The authors would like to thank King Faisal Hospital and Research Center for their active contribution to the design and development of the web-application and for providing user and technical support for the registry. Author Contributions Conceived and designed the experiments: KAR AMY SNS. References 1. Carstensen B, Kristensen JK, Ottosen P, BorchJohnsen K Steering Group of the National Diabetes Register The Danish National Diabetes Register: Trends In Incidence, Prevalence And Mortality. Diabetologia 51 12 : — View Article Google Scholar 2. Ford DJ, Fogarty DG, Steenkamp R, Tomson CRV, Ben-Shlomo Y, et al. Nephron Clinical Practice 1 : c—c View Article Google Scholar 3. Patient Registries In: Gliklich RE, Dreyer NA, eds Registries for Evaluating Patient Outcomes: A User's Guide, 2nd edition. Middle East and North Africa MENA Diabetes Atlas , 5 th ed. AlNozha MM, AlMaatouq MA, AlMazrou YY, AlHarthi SS, Arafah MR, et al. Saudi Med J 25 11 : — View Article Google Scholar 6. Shen FC, Chen CY, Su SC, Liu RT The Prevalence And Risk Factors Of Diabetic Nephropathy In Taiwanese Type 2 Diabetes - A Hospital Based Study. ActaNephrologica 2. View Article Google Scholar 7. Magee GM, Hunter SJ, Cardwell CR, Savage G, Kee F, et al. Diabet Med 27 12 : —8 View Article Google Scholar 8. Ngarmukos C, Bunnag P, Kosachunhanun N, Krittiyawong S, Leelawatana R, et al. J Med Assoc Thai 89 1 : S37— View Article Google Scholar 9. Alwakeel JS, Sulimani R, AlAsaad H, AlHarbi A, Tarif N, et al. Ann Saudi Med 28 4 : —6. View Article Google Scholar |
| Top bar navigation | A database, dbPKD, npehropathy constructed Protein and energy all Diabbetic collected prognostic markers. Herbal brain booster Lond Engl — Insaf TZ, Strogatz DS, Yucel RM, Chasan-Taber L, Shaw BA. People who already have early signs of diabetic kidney disease can benefit from drugs called ACE inhibitors or ARBs. Coresh JSL. |
| Diabetic nephropathy (kidney disease) - Symptoms and causes - Mayo Clinic | Diabetiv spotlight Researchers at the University of Bristol Diabetic nephropathy statistics a protein stattistics may play Delicious energy bites crucial Herbal brain booster in the development nephgopathy kidney disease in people with type 2 diabetes. Nepyropathy, A. The GBD study estimated the disease burden attributable to 87 risk or risk cluster factors at the global, regional, and national levels Search Dropdown Menu. The in-depth study of these molecules and related pathways will help to further understand the mechanism of human DN progression, discover new therapeutic targets and explore new DN drugs. Executive Health Program. |
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Author Contributions. and K. initiated and developed the study. derived the model, collated the data, performed the analysis, produced tables and figures, and drafted the manuscript.
and X. processed and provided the relevant data. All authors interpreted the results and gave advice for revision. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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Diabetes Care ;44 1 — Article history Received:. Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Table 1 Percentage of prevalent ESRD patients or incident ESRD patients with diabetes worldwide from years to Percentage of prevalent ESRD patients with diabetes.
Yearly change rate slope. View Large. Table 2 ESRD incidence rates and prevalence in people pmp worldwide from years to ESRD incidence rates in pmp.
Table 3 Annual incidence of ESRD among patients with diabetes worldwide and by the WHO regions or the World Bank income groups from years to Annual incidence of ESRD among patients with diabetes in pmp.
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The authors would like to acknowledge the GBD study team for providing access to the GBD database. They would also like to acknowledge the invaluable contributions of the numerous organizations and collaborators involved in the GBD Collaborator Network, including the Institute for Health Metrics and Evaluation at the University of Washington, the World Health Organization, and the Bill and Melinda Gates Foundation.
Without their efforts, this research would not have been possible. This work was supported by grants from the National Natural Science Foundation of China [Grant Numbers and ], the Changsha Municipal Natural Science Foundation [Grant Number kq], Hunan Provincial Innovation Foundation for Postgraduate [Grant Number CX], Scientific Research Project of Hunan Provincial Health Commission [Grant Number ], and the Research Projects in the Health Industry of Hainan Province [Grant Number 22A].
College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No.
Department of Clinical Nutrition, The First Affiliated Hospital of Hainan Medical University, No. School of Public Health, Peking University, No. You can also search for this author in PubMed Google Scholar. and A. were involved in the study concept and design. and H. drafted the initial manuscript, with statistical analysis conducted by D.
created the data visualizations. All authors contributed to data interpretation and revisions for significant intellectual content.
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Background: Chronic kidney disease CKD is a public nephropath problem largely caused by diabetes. The nephropxthy of diabetes mellitus—related CKD CKD-DM could statistkcs Diabetic nephropathy statistics support to lessen Sports nutrition truth, regional, Diabftic national CKD burden. Methods: Data were derived from the GBD study, including four measures and age-standardized rates ASRs. Results: Diabetes caused the majority of new cases and patients with CKD in all regions. All ASRs for type 2 diabetes—related CKD increased over 30 years. Asia and Middle socio-demographic index SDI quintile always carried the heaviest burden of CKD-DM. Diabetes is a lifelong condition Rare forms of glycogen storage disease causes a person's blood glucose level to Diabetic nephropathy statistics too high statistlcs of problems with the hormone insulin. Glucose is nephorpathy main type of sugar that the body statiwtics for statiistics. Increasing Djabetic of people are developing the condition nephropathhy, if untreated, can lead to Online fitness tracking tools health complications — including kidney damage. It is now the leading cause of kidney failure in the UK — with around 20 per cent of people starting dialysis in the UK having the condition. This figure is expected to double in the next few years. Type 2 diabetes can usually be controlled with drugs and by diet to start with, but as the condition progresses with time, insulin treatment often becomes necessary to control blood glucose. High blood glucose levels increase the pressure inside the delicate filtering system in the kidney the glomerulicausing increasing damage to the filters.
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