- Diabetes affects about 7.5% of the adult population in the UK. One of the important complications of long-term diabetes is kidney damage. Although it only affects a minority of people with diabetes, it is a significant cause of kidney failure, which may require treatment with dialysis or kidney transplantation. The literature suggests that the prevalence of chronic kidney disease (CKD) as a result of diabetes varies from 18% to over 30% in all people with diabetes.
- Diabetic patients can develop CKD and this is usually a result of diabetic nephropathy or vascular damage caused by diabetes.
- A World Health Organisation (WHO) study in 10 countries found that kidney disease accounted for 21% of all deaths for patients with type1 diabetes, and 11% of patients with type 2 diabetes.
- Classic diabetes with kidney disease if often classified by the extent of protein excretion in the urine. Early kidney disease results in the appearance of small amounts of albumin (a protein which is routinely made by the liver) in the urine (previously called ‘microalbuminuria’). The presence of small amounts of albumin in the urine may come and go, but its continuous presence is evidence of early diabetes with kidney disease (also known as diabetic nephropathy).
- AKI is common in people who develop acute illness and can result in severe, life threatening complications. Diabetes, proteinuria and chronic kidney disease (CKD) are all independent risk factors for the development of AKI. This has led to the recommendation that patients with these risk factors should be identified, and appropriate preventative measures should be instituted, as early as possible in their management23.
- Although the measurement of UAE is the cornerstone for the diagnosis of diabetic nephropathy, there are some patients with either type 1 or type 2 diabetes who have decreased glomerular filtration rate (GFR) in the presence of normal UAE. In patients with type 1 diabetes, this phenomenon seems to be more common among female patients with longstanding diabetes, hypertension, and/or retinopathy.
- For patients with type 2 diabetes in NHANES III (Third National Health and Nutrition Examination Survey; n = 1,197), low GFR ( <60 ml • min-1 • 1.73 m-2) was present in 30% of patients in the absence of micro- or macroalbuminuria and retinopathy. Although renal biopsy was not performed, this observation was probably related to renal parenchymal disease other than classical diabetic glomerulosclerosis. These studies indicate that normoalbuminuria does not protect from a decrease in GFR in type 1 and type 2 diabetic patients.
Association of Public Health Observatories Diabetes Prevalence Model: Yorkshire & Humber Public Health Observatory
The unrecognized prevalence of chronic kidney disease in diabetes Nephrol Dial Transplant (2006) 21:88-92
Diabetes UK http://diabetes.org.uk/Documents/Reports/
Diabetic Nephropathy: Diagnosis, Prevention and Treatment
Diabetes Care 28: 176-188, 2005
JAMA 289:3273-3277, 2003