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CHANGING TRENDS IN END‐STAGE RENAL DISEASE DUE TO DIABETES IN THE UNITED KINGDOM
Author(s) -
Hill C. J.,
Fogarty D. G.
Publication year - 2012
Publication title -
journal of renal care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.381
H-Index - 27
eISSN - 1755-6686
pISSN - 1755-6678
DOI - 10.1111/j.1755-6686.2012.00273.x
Subject(s) - medicine , renal replacement therapy , dialysis , diabetes mellitus , diabetic nephropathy , end stage renal disease , disease , population , incidence (geometry) , transplantation , kidney transplantation , stage (stratigraphy) , kidney disease , intensive care medicine , pediatrics , endocrinology , paleontology , physics , environmental health , optics , biology
SUMMARY Background: In some countries, diabetic kidney disease (DKD) is responsible for half of all new patients requiring renal replacement therapy (RRT). Understanding the relationship between early and later stages of DKD is important as it is a preventable cause of renal failure. This review aims to establish the trends in end‐stage renal disease (ESRD) due to diabetes in the United Kingdom as the first step in this understanding. Methods: Using annual reports from the UK Renal Registry, we summarise the presentation, incidence, prevalence and survival of ESRD patients with diabetes over the last 10–15 years. Results: Between 1995 and 2009, initiation of RRT in diabetes patients increased from 12.3 to 27.6 patients per million population (pmp). These rates are approximately five times less than those of Caucasians in the United States suggesting fundamental differences in early DKD management. Survival of diabetic patients on dialysis has improved such that prevalent numbers on RRT increased from 47 to 117 pmp in a 12‐year period. A longer time to prepare patients for RRT is strongly related with better outcomes. In 2002, 23% of all patients with diabetic nephropathy were referred late, within 90 days of RRT start; by 2009, this figure had fallen to 11.2%. Access to renal transplantation, the best form of RRT, has improved with almost 12.5% of new transplants occurring in patients with diabetes compared to 8.3% in 1997. Conclusions: End Stage DKD is more extensively and better treated now than in the late 1990s and coincides with a time of rapid expansion of UK renal services. More diabetes patients start RRT, patients are referred earlier and survive longer. The prevalence of end‐stage DKD is 2.5 times what it was just over 10 years ago. However, across the United Kingdom, there still exists variation in the incidence and outcomes of end‐stage DKD. That these figures have grown so much but are still dwarfed by other countries’ burden of DKD merits further research. Further prevention of DKD is achievable for the United Kingdom and particularly critical for developing nations who can least afford the expensive ‘option’ of RRT.