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When I was a medical student in the 1960s, about one-third of patients with type 1 diabetes developed end-stage renal disease (ESRD) by ∼30 years’ duration of diabetes (1), and there wasn’t anything that could be done for them. Medicare only started paying for treatment of ESRD (dialysis/transplantation) in the United States in 1973. So, most of those patients died. Recently, the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study showed that the cumulative incidences of ESRD were only 1% in the initial DCCT intensive therapy group and 2% in the initial conventional therapy group in subjects who had a mean diabetes duration of 28 years (2). Now, that’s a difference!Comparable numbers for type 2 diabetes are more difficult to interpret because of the very high competing risk of death from cardiovascular disease (CVD) in such patients and the various interventions that may differentially affect chronic kidney disease (CKD) versus CVD progression in this population. However, it is clear from analyses of the U.S. Renal Data System that the overall proportion of diabetic patients developing ESRD has decreased progressively and substantially since 1996 (3).Nonetheless, the absolute number of diabetic patients developing ESRD and the percentage of patients whose ESRD is the result of diabetes continue to increase because of the overall increase in the incidence of diabetes itself in the …

Diabetic Kidney Disease: Much Progress, But Still More to Do