Materiały źródłowe

• #1 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries, including the United States. […] Approximately 30% to 40% of patients with diabetes mellitus develop diabetic nephropathy. […] By 2045, the global incidence of diabetes is projected to exceed 783 million, and by 2030, diabetic complications are expected to become the seventh leading cause of mortality. […] In the United States, the Centers for Disease Control and Prevention (CDC) reports that 14% of individuals aged 20 or older are affected by CKD, with 30% of those also having diabetes.

• #2 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  Diabetic kidney disease which is defined by elevated urine albumin excretion or reduced glomerular filtration rate (GFR) or both is a serious complication that occurs in 20% to 40% of all diabetics. […] The prevalence of diabetes worldwide has extended epidemic magnitudes and is expected to affect more than 350 million people by the year 2035. […] There is marked racial/ethnic besides international difference in the epidemiology of diabetic kidney disease which could be explained by the differences in economic viability and governmental infrastructures. […] Approximately one-third of diabetic patients showed microalbuminuria after 15 years of disease duration and less than half develop real nephropathy. […] Diabetic kidney disease (DKD) is more frequent in African-Americans, Asian-Americans, and Native Americans.

• #2 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). […] Diabetic kidney disease (DKD) affects about 20% of patients with diabetes. […] DKD is associated with increased risks of morbidity and mortality and is the leading cause of end-stage renal disease (ESRD) in the United States. […] Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion. […] Prevention of diabetes in the general population is the most effective means of minimizing the impact of DKD; understanding risk factors for DKD development can help with early identification and intervention. […] Screening for microalbuminuria can be completed in three ways: 24-hour collection with creatinine, allowing for simultaneous measurement of creatinine clearance; timed (four-hour or overnight) collection; or measurement of the albumin/creatinine ratio in a random spot collection.

• #3 Diabetic kidney disease | Nature Reviews Disease Primers

  https://www.nature.com/articles/nrdp201518

  The kidney is arguably the most important target of microvascular damage in diabetes. A substantial proportion of individuals with diabetes will develop kidney disease owing to their disease and/or other co-morbidity, including hypertension and ageing-related nephron loss. The presence and severity of chronic kidney disease (CKD) identify individuals who are at increased risk of adverse health outcomes and premature mortality. Consequently, preventing and managing CKD in patients with diabetes is now a key aim of their overall management. […] Intensive management of patients with diabetes includes controlling blood glucose levels and blood pressure as well as blockade of the reninangiotensinaldosterone system; these approaches will reduce the incidence of diabetic kidney disease and slow its progression. Indeed, 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 remains an unmet need for innovative treatment strategies to prevent, arrest, treat and reverse DKD.

• #3 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  Diabetic nephropathy, also known as diabetic kidney disease, is the chronic loss of kidney function occurring in those with diabetes mellitus. Diabetic nephropathy is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) globally. […] Diabetic nephropathy is the most common cause of end-stage renal disease and is a serious complication that affects approximately one quarter of adults with diabetes in the United States. […] Diabetic nephropathy affects approximately a third of patients with type 1 and type 2 diabetes mellitus. Diabetic nephropathy is responsible for about a third of cases of ESRD worldwide, and an even larger fraction in the developed countries. […] The prevalence of diabetes is projected to increase from 382 million in 2013, to over 592 million by 2035. This increase is projected to be sharpest in developed countries. The prevalence of type 2 DM is particularly increasing due to the rising prevalence of obesity worldwide.

• #4 Diabetic Nephropathy | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-90684-9_37

  Diabetes mellitus (DM) is the most frequent cause of severe chronic kidney disease (CKD) and is the leading cause of end-stage renal disease (ESRD) in Western countries. […] Diabetic nephropathy is a specific renal condition characterized by hyperfiltration, persistent urinary albumin-to-creatinine ratio (UACR) 30 mg/g, continuous decline in the glomerular filtration rate (GFR), raised arterial blood pressure (BP), and enhanced cardiovascular morbidity and mortality. […] Early diagnosis and appropriate management, especially when associated with control of glycemia, blood pressure, and other comorbidities, may be related to better outcomes.

• #4 The Epidemiology of Diabetic Kidney Disease

  https://www.mdpi.com/2673-8236/2/3/38

  Diabetic kidney disease (DKD) is a frequent long-term complication of diabetes. Globally, DKD is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), accounting for 50% of cases. Approximately 20–50% of patients with T2DM will ultimately develop DKD. The kidney is an important target of microvascular damage in diabetes. Diabetic patients have twice the risk of CKD as those without diabetes. Diabetic kidney disease develops in nearly half of patients with T2DM and one-third of those with T1DM during their lifetime. It is one of the most frequent, burdensome, and expensive long-term complications of diabetes. The percentage of patients who have CKD caused by diabetes is not precisely known, since people with diabetes may have other causes of CKD in addition to diabetes. The prevalence of CKD, especially the earlier stages, is higher in women, but men are more likely to progress to ESKD for which KRT is needed. The largest treatment gaps were noted in low-income countries, particularly in Asia and Africa, where 1.9 and 0.4 million people were needing, but not receiving KRT. Worldwide, the prevalence of KRT is projected to more than double to 5.4 million people by 2030, with the most growth in Asia. In patients with T2DM the prevalence of CKD varies in countries across the world, ranging from 27% in China to 84% in Tanzania. The global epidemiology of T2DM is changing from a chronic disease in middle aged and older people, into one that is increasingly common at younger ages, including in young adults, adolescents, and children. The course of DKD is heterogeneous, owing to its different underlying causes. DKD has emerged as a major consequence of the global diabetes pandemic, largely driven by obesity. Therefore, diabetes and obesity prevention are the cornerstones of reducing the burden of DKD. Identification of DKD depends on screening for increased albuminuria and low kidney function.

• #5 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  The predictive value of microalbuminuria for the progression of kidney damage in patients with type 1 or 2 DM was confirmed in the early 1980s. […] Almost 20% to 30% of the patients progress to microalbuminuria after 15 years of disease duration and less than half develop real nephropathy. […] The prevalence of DKD in most type 2 diabetics – at any point in time – is approximately 30%-50%, and this was reported among US diabetic adults (90% type 2). […] The prevalence of diabetes especially type 2 is greater in certain races and ethnic groups, affecting approximately 13% of African Americans, 9.5% of Hispanics, and 15% of Native Americans. […] Nearly 20% to 30% of all diabetics will progress to evident nephropathy, although a greater percentage of type 1 patients progress to ESKD. […] The high mortality risk observed among people with both types 1 and 2 diabetes is largely confined to those with evidence of DKD because it is associated with a number of interrelated cardiovascular diseases, including micro, and macroangiopathies. […] Diabetic kidney disease is not uncommon complication of diabetes (type 1 and 2) all over the world and among geriatric population.

• #6 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Since the 1950s, kidney disease has been clearly recognized as a common complication of diabetes mellitus (DM), with as many as 50% of patients with DM of more than 20 years duration having this complication. […] Diabetic nephropathy rarely develops before 10 years duration of type 1 DM (previously known as insulin-dependent diabetes mellitus [IDDM]). Approximately 3% of newly diagnosed patients with type 2 DM (previously known as noninsulin-dependent diabetes mellitus [NIDDM]) have overt nephropathy. The peak incidence (3%/y) is usually found in persons who have had diabetes for 10-20 years, after which the rate progressively declines. […] In terms of diabetic kidney disease in the United States, the prevalence increased from 1988-2008 in proportion to the prevalence of diabetes. Among people with diabetes, the prevalence of diabetic kidney disease remained stable.

• #7 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Striking epidemiologic differences exist even among European countries. In some European countries, particularly Germany, the proportion of patients admitted for renal replacement therapy exceeds the figures reported from the United States. […] A study from the Netherlands suggested that diabetic nephropathy is underdiagnosed. Using renal tissue specimens from autopsies, Klessens et al found histopathologic changes associated with diabetic nephropathy in 106 of 168 patients with type 1 or type 2 diabetes. […] A retrospective study from China, by Fan and Wang, indicated that in type 2 diabetes patients with renal injury, there is a high prevalence of nondiabetic renal disease (NDRD). […] Diabetic nephropathy affects males and females equally. […] Diabetic nephropathy rarely develops before 10 years duration of type 1 DM. The peak incidence (3%/y) is usually found in persons who have had diabetes for 10-20 years.

• #8 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  Diabetic kidney disease which is defined by elevated urine albumin excretion or reduced glomerular filtration rate (GFR) or both is a serious complication that occurs in 20% to 40% of all diabetics. […] The prevalence of diabetes worldwide has extended epidemic magnitudes and is expected to affect more than 350 million people by the year 2035. […] There is marked racial/ethnic besides international difference in the epidemiology of diabetic kidney disease which could be explained by the differences in economic viability and governmental infrastructures. […] Approximately one-third of diabetic patients showed microalbuminuria after 15 years of disease duration and less than half develop real nephropathy. […] Diabetic kidney disease (DKD) is more frequent in African-Americans, Asian-Americans, and Native Americans.

• #9 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  Diabetic kidney disease which is defined by elevated urine albumin excretion or reduced glomerular filtration rate (GFR) or both is a serious complication that occurs in 20% to 40% of all diabetics. […] The prevalence of diabetes worldwide has extended epidemic magnitudes and is expected to affect more than 350 million people by the year 2035. […] There is marked racial/ethnic besides international difference in the epidemiology of diabetic kidney disease which could be explained by the differences in economic viability and governmental infrastructures. […] Approximately one-third of diabetic patients showed microalbuminuria after 15 years of disease duration and less than half develop real nephropathy. […] Diabetic kidney disease (DKD) is more frequent in African-Americans, Asian-Americans, and Native Americans.

• #10 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  The incidence of DKD as a cause of ESKD is increasing each year. […] The prevalence of diabetes around the world has reached epidemic proportions. […] It has been estimated that more than 40% of people with diabetes will develop chronic kidney disease (CKD), including a significant number who will develop ESKD requiring renal replacement therapies (dialysis and or transplantation). […] There is marked racial/ethnic and international difference in the epidemiology of DKD. […] Native Americans, Hispanics and African-Americans have a much greater risk of developing ESKD than non-Hispanic whites with type 2 diabetes. […] Based on 2002 US data, diabetes is the cause of renal disease in 44% to 45% of incident ESKD cases, making the US rate one of the highest worldwide. […] Internationally, considerable variability among countries, with percentages fluctuating from nine percent in Russia to forty nine percent in Malaysia.

• #11 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  The incidence of DKD as a cause of ESKD is increasing each year. […] The prevalence of diabetes around the world has reached epidemic proportions. […] It has been estimated that more than 40% of people with diabetes will develop chronic kidney disease (CKD), including a significant number who will develop ESKD requiring renal replacement therapies (dialysis and or transplantation). […] There is marked racial/ethnic and international difference in the epidemiology of DKD. […] Native Americans, Hispanics and African-Americans have a much greater risk of developing ESKD than non-Hispanic whites with type 2 diabetes. […] Based on 2002 US data, diabetes is the cause of renal disease in 44% to 45% of incident ESKD cases, making the US rate one of the highest worldwide. […] Internationally, considerable variability among countries, with percentages fluctuating from nine percent in Russia to forty nine percent in Malaysia.

• #12 Diabetic nephropathy – complications and treatment | IJNRD

  https://www.dovepress.com/diabetic-nephropathy-ndash-complications-and-treatment-peer-reviewed-fulltext-article-IJNRD

  Diabetic nephropathy is a significant cause of chronic kidney disease and end-stage renal failure globally. […] The diabetes epidemic has resulted in DN becoming the most frequent cause of end-stage renal disease (ESRD) in most countries. […] In 2009-2011, diabetes was the primary cause of ESRD in about 60% of patients in Malaysia, Mexico, and Singapore. […] The incidence of ESRD due to diabetes also rises in the older age group. […] Thus, the reason for this boom in diabetes-associated ESRD is the increasing prevalence of diabetes and the aging population. […] The main modifiable risks are hypertension, glycemic control, and dyslipidemia. […] Not all diabetics develop DN and in those who do, progression is variable. […] A meta-analysis of studies identified 24 genetic variants in 16 genes which are associated with DN.

• #13 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Striking epidemiologic differences exist even among European countries. In some European countries, particularly Germany, the proportion of patients admitted for renal replacement therapy exceeds the figures reported from the United States. […] A study from the Netherlands suggested that diabetic nephropathy is underdiagnosed. Using renal tissue specimens from autopsies, Klessens et al found histopathologic changes associated with diabetic nephropathy in 106 of 168 patients with type 1 or type 2 diabetes. […] A retrospective study from China, by Fan and Wang, indicated that in type 2 diabetes patients with renal injury, there is a high prevalence of nondiabetic renal disease (NDRD). […] Diabetic nephropathy affects males and females equally. […] Diabetic nephropathy rarely develops before 10 years duration of type 1 DM. The peak incidence (3%/y) is usually found in persons who have had diabetes for 10-20 years.

• #14 The Epidemiology of Diabetic Kidney Disease

  https://www.mdpi.com/2673-8236/2/3/38

  Diabetic kidney disease (DKD) is a frequent long-term complication of diabetes. Globally, DKD is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), accounting for 50% of cases. Approximately 20–50% of patients with T2DM will ultimately develop DKD. The kidney is an important target of microvascular damage in diabetes. Diabetic patients have twice the risk of CKD as those without diabetes. Diabetic kidney disease develops in nearly half of patients with T2DM and one-third of those with T1DM during their lifetime. It is one of the most frequent, burdensome, and expensive long-term complications of diabetes. The percentage of patients who have CKD caused by diabetes is not precisely known, since people with diabetes may have other causes of CKD in addition to diabetes. The prevalence of CKD, especially the earlier stages, is higher in women, but men are more likely to progress to ESKD for which KRT is needed. The largest treatment gaps were noted in low-income countries, particularly in Asia and Africa, where 1.9 and 0.4 million people were needing, but not receiving KRT. Worldwide, the prevalence of KRT is projected to more than double to 5.4 million people by 2030, with the most growth in Asia. In patients with T2DM the prevalence of CKD varies in countries across the world, ranging from 27% in China to 84% in Tanzania. The global epidemiology of T2DM is changing from a chronic disease in middle aged and older people, into one that is increasingly common at younger ages, including in young adults, adolescents, and children. The course of DKD is heterogeneous, owing to its different underlying causes. DKD has emerged as a major consequence of the global diabetes pandemic, largely driven by obesity. Therefore, diabetes and obesity prevention are the cornerstones of reducing the burden of DKD. Identification of DKD depends on screening for increased albuminuria and low kidney function.

• #15

  https://www.jci.org/articles/view/72271

  Diabetic kidney disease (DKD) is the leading cause of kidney failure worldwide and the single strongest predictor of mortality in patients with diabetes. […] In the United States about 200,000 patients receive ESRD care due to DKD, with 50,000 new patients starting dialysis each year. […] DKD is usually classed as a microvascular complication of diabetes. […] Podocyte loss may follow from hyperglycemia-induced ROS generation causing podocyte apoptosis or detachment. […] Podocyte dropout is a critical factor for DKD development. […] DKD-specific lesions are observed in glomeruli, consistent with the cardinal role for podocytes in DKD. […] Podocytes have received special interest as they cannot be replaced, indicating that their loss and injury represent an irreversible step in disease development.

• #16 Chronic Kidney Disease (CKD): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238798-overview

  The adjusted incidence of end-stage kidney disease (ESKD) in the US fell by 8.9% from 2000 to 2019. Over that period, however, the number of patients with newly registered ESKD rose from 97,856 to 134,837, an increase of 37.8%. […] In 2023, more than 808,000 people in the US (2 per 1000 population) were currently living with ESKD. […] The US Surgeon General’s latest report on 10-year national objectives for improving the health of all Americans, Healthy People 2030, contains a chapter focused on CKD. For 2030, Healthy People lays out 14 objectives concerning reduction of the US incidence, morbidity, mortality, and health costs of CKD. Reducing kidney failure will require additional public health efforts, including effective preventive strategies and early detection and treatment of CKD.

• #17 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  Diabetic kidney disease progression could lead to ESRD as well as an increased risk of cardiovascular complications, all of which cause a substantial economic burden. The estimated cost of management of patients with ESRD due to diabetic nephropathy in the US is US$39.35 billion in 2010. […] Within developed countries, certain ethnic groups such as African Americans and Native Americans are at higher risk of developing diabetic nephropathy and ESRD.

• #18 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  The predictive value of microalbuminuria for the progression of kidney damage in patients with type 1 or 2 DM was confirmed in the early 1980s. […] Almost 20% to 30% of the patients progress to microalbuminuria after 15 years of disease duration and less than half develop real nephropathy. […] The prevalence of DKD in most type 2 diabetics – at any point in time – is approximately 30%-50%, and this was reported among US diabetic adults (90% type 2). […] The prevalence of diabetes especially type 2 is greater in certain races and ethnic groups, affecting approximately 13% of African Americans, 9.5% of Hispanics, and 15% of Native Americans. […] Nearly 20% to 30% of all diabetics will progress to evident nephropathy, although a greater percentage of type 1 patients progress to ESKD. […] The high mortality risk observed among people with both types 1 and 2 diabetes is largely confined to those with evidence of DKD because it is associated with a number of interrelated cardiovascular diseases, including micro, and macroangiopathies. […] Diabetic kidney disease is not uncommon complication of diabetes (type 1 and 2) all over the world and among geriatric population.

• #19

  https://journals.lww.com/cjasn/fulltext/2017/12000/diabetic_kidney_disease__challenges,_progress,_and.17.aspx

  Diabetic kidney disease develops in approximately 40% of patients who are diabetic and is the leading cause of CKD worldwide. […] The increasing prevalence of DKD parallels the dramatic worldwide rise in prevalence of diabetes. […] Kidney disease attributed to diabetes is a major but under-recognized contributor to the global burden of disease. […] DKD risk factors can conceptually be classified as susceptibility factors (e.g., age, sex, race/ethnicity, and family history), initiation factors (e.g., hyperglycemia and AKI), and progression factors (e.g., hypertension, dietary factors, and obesity). […] In normoalbuminuric patients with DM1, poor glycemic control is an independent predictor of progression to development of proteinuria (albuminuria) and/or ESRD. […] Development of DKD is associated with many alterations in the structure of multiple kidney compartments.

• #20 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  The severity and incidence of diabetic nephropathy are especially great in Blacks (the frequency being 3- to 6-fold higher than it is in Whites), Mexican Americans, and Pima Indians with type 2 DM. The relatively high frequency of the condition in these genetically disparate populations suggests that socioeconomic factors, such as diet, poor control of hyperglycemia, hypertension, and obesity, have a primary role in the development of diabetic nephropathy. […] By age 20 years, as many as half of all Pima Indians with diabetes have developed diabetic nephropathy, with 15% of these individuals having progressed to ESRD.

• #21 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  The severity and incidence of diabetic nephropathy are especially great in Blacks (the frequency being 3- to 6-fold higher than it is in Whites), Mexican Americans, and Pima Indians with type 2 DM. The relatively high frequency of the condition in these genetically disparate populations suggests that socioeconomic factors, such as diet, poor control of hyperglycemia, hypertension, and obesity, have a primary role in the development of diabetic nephropathy. […] By age 20 years, as many as half of all Pima Indians with diabetes have developed diabetic nephropathy, with 15% of these individuals having progressed to ESRD.

• #22 Chronic Kidney Disease (CKD): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238798-overview

  In the United States, more than 1 in 7 adults (14% of the adult population, or 35.5 million people) are estimated to have chronic kidney disease (CKD). Kidney disease is the ninth leading cause of death in the United States. […] According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the overall prevalence of CKD in the US has remained relatively stable since 2004. The largest increase occurred in people with stage 3 CKD, from 4.5% to 6.0%. […] In the US, the prevalence of CKD increases dramatically with age: it is 6% in persons 18 to 44 years, 12% in those 45 to 64 years, and 34% in those 65 or older. […] According to 2017-March 2020 NHANES data, the estimated prevalence of CKD in adults by stage was as follows: Stage 3: 5.1%; Stage 4: 0.3%; Stage 5: 0.2%.

• #23 Diabetes & Kidneys | International Diabetes Federation

  https://idf.org/about-diabetes/diabetes-complications/diabetes-and-the-kidneys/

  The most common risk factors for CKD are high blood glucose, obesity, hypertension, and blood lipid abnormalities. […] Early detection and intervention can help prevent or slow down the progression of kidney disease while maintaining glucose and blood pressure levels at target levels can lower the risk.

• #24 Prevalence and predictors of chronic kidney disease among type 2 diabetic patients worldwide, systematic review and meta-analysis | Diabetology & Metabolic Syndrome | Full Text

  https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-023-01202-x

  CKD is estimated to affect 50% patients with T2DM globally, and its presence and severity markedly influences disease prognosis. […] The incident cases of CKD as a result of type 2 diabetes mellitus worldwide in 2017 had increased by 74% compared with 1990. […] Diabetes is the leading cause of CKD in all developed and most developing countries, with approximately 20% of people with type 2 diabetes showing evidence of diabetic nephropathy within 20 years of diabetes onset. […] Studies showed that early detection and treatment of diabetes and chronic diseases can slow or prevent the progression of CKD. […] The study revealed that being old age, hypertension, cardiac disease, smoking, obesity, having type 2 diabetes mellitus was predictor variable for presence of chronic kidney disease among type 2 diabetic patients.

• #25 Prevalence and predictors of chronic kidney disease among type 2 diabetic patients worldwide, systematic review and meta-analysis | Diabetology & Metabolic Syndrome | Full Text

  https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-023-01202-x

  Diabetes is the leading cause of CKD. […] The pooled magnitude of chronic kidney disease among type 2 DM patients was 27% (95% CI 21%, 33%). […] Patients with CKD have an elevated risk of severe renal and cardiovascular morbidity and mortality. […] In this systematic review and meta-analysis increased age, obesity, having a history of type 2 diabetes mellitus, smoking history, presence of hypertension, and cardiac heart disease were factors significantly associated with the presence of chronic kidney disease among type 2 diabetic patients. […] The prevalence of chronic kidney disease among type 2 diabetes mellitus patients was high based on the included 20 articles. […] The review reported that old age, hypertension, cardiac disease, smoking, obesity, and duration of diabetes mellitus was predictor variable for chronic kidney disease among type 2 diabetic patients.

• #26 JMIR Public Health and Surveillance – Prevalence and Risk Factors of Chronic Kidney Disease in Patients With Type 2 Diabetes in China: Cross-Sectional Study

  https://publichealth.jmir.org/2024/1/e54429

  Chronic kidney disease (CKD) has emerged as a prominent long-term complication of diabetes, affecting approximately 30% of patients with type 1 diabetes and 40% of those with type 2 diabetes. […] A national study from December 2021 to September 2022 enlisted 9672 participants with type 2 diabetes from 45 hospitals that had endocrinology departments. The prevalence, screening, and awareness rates of CKD among patients with type 2 diabetes were 31% (2997/9672), 27% (810/2997), and 54.8% (5295/9672), respectively. […] The rising incidence of diabetes correlates with an increase in ESKD cases, with approximately 50% attributed to diabetes-related CKD in high-income nations. […] The factors associated with CKD in the univariate analyses included awareness; age; duration of diabetes; concurrent use of antihypertensive drugs, lipid regulators, antiplatelet agents, and microcirculation-improving agents; absence of concomitant drug use, except hypoglycemic agents; BMI; hypertension; elevated LDL-C and poor glycemic control; and diabetic foot, diabetic retinopathy, diabetic neuropathy, diabetic lower extremity arteriopathy, and cardiovascular disease. […] This cross-sectional study underscored a concerning 31% prevalence of CKD and notably low rates of CKD screening and awareness among adult Chinese patients with type 2 diabetes.

• #27 The Epidemiology of Diabetic Kidney Disease

  https://www.mdpi.com/2673-8236/2/3/38

  Diabetic kidney disease (DKD) is a frequent long-term complication of diabetes. Globally, DKD is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), accounting for 50% of cases. Approximately 20–50% of patients with T2DM will ultimately develop DKD. The kidney is an important target of microvascular damage in diabetes. Diabetic patients have twice the risk of CKD as those without diabetes. Diabetic kidney disease develops in nearly half of patients with T2DM and one-third of those with T1DM during their lifetime. It is one of the most frequent, burdensome, and expensive long-term complications of diabetes. The percentage of patients who have CKD caused by diabetes is not precisely known, since people with diabetes may have other causes of CKD in addition to diabetes. The prevalence of CKD, especially the earlier stages, is higher in women, but men are more likely to progress to ESKD for which KRT is needed. The largest treatment gaps were noted in low-income countries, particularly in Asia and Africa, where 1.9 and 0.4 million people were needing, but not receiving KRT. Worldwide, the prevalence of KRT is projected to more than double to 5.4 million people by 2030, with the most growth in Asia. In patients with T2DM the prevalence of CKD varies in countries across the world, ranging from 27% in China to 84% in Tanzania. The global epidemiology of T2DM is changing from a chronic disease in middle aged and older people, into one that is increasingly common at younger ages, including in young adults, adolescents, and children. The course of DKD is heterogeneous, owing to its different underlying causes. DKD has emerged as a major consequence of the global diabetes pandemic, largely driven by obesity. Therefore, diabetes and obesity prevention are the cornerstones of reducing the burden of DKD. Identification of DKD depends on screening for increased albuminuria and low kidney function.

• #28 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Striking epidemiologic differences exist even among European countries. In some European countries, particularly Germany, the proportion of patients admitted for renal replacement therapy exceeds the figures reported from the United States. […] A study from the Netherlands suggested that diabetic nephropathy is underdiagnosed. Using renal tissue specimens from autopsies, Klessens et al found histopathologic changes associated with diabetic nephropathy in 106 of 168 patients with type 1 or type 2 diabetes. […] A retrospective study from China, by Fan and Wang, indicated that in type 2 diabetes patients with renal injury, there is a high prevalence of nondiabetic renal disease (NDRD). […] Diabetic nephropathy affects males and females equally. […] Diabetic nephropathy rarely develops before 10 years duration of type 1 DM. The peak incidence (3%/y) is usually found in persons who have had diabetes for 10-20 years.

• #29 Diabetes & Kidneys | International Diabetes Federation

  https://idf.org/about-diabetes/diabetes-complications/diabetes-and-the-kidneys/

  Kidney disease (diabetic nephropathy) is caused by damage to small blood vessels in the kidneys, leading to inefficient kidney function or failure. It is more prevalent in people with diabetes. Maintaining normal blood glucose and blood pressure levels can significantly decrease the risk of kidney disease. […] Diabetes is one of the leading causes of chronic kidney disease (CKD), with up to 40% of people living with diabetes affected by CKD. This IDF Diabetes Atlas report looks at the relationship between diabetes and kidney disease across the globe and ways to reduce its impact. […] Studies have shown that people from racial, ethnic and minority groups living in Western societies are at higher risk of developing kidney disease. Similarly, women with diabetes have a higher likelihood of experiencing kidney complications compared to their male counterparts.

• #30 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries, including the United States. […] Approximately 30% to 40% of patients with diabetes mellitus develop diabetic nephropathy. […] By 2045, the global incidence of diabetes is projected to exceed 783 million, and by 2030, diabetic complications are expected to become the seventh leading cause of mortality. […] In the United States, the Centers for Disease Control and Prevention (CDC) reports that 14% of individuals aged 20 or older are affected by CKD, with 30% of those also having diabetes.

• #31 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  Diabetic kidney disease which is defined by elevated urine albumin excretion or reduced glomerular filtration rate (GFR) or both is a serious complication that occurs in 20% to 40% of all diabetics. […] The prevalence of diabetes worldwide has extended epidemic magnitudes and is expected to affect more than 350 million people by the year 2035. […] There is marked racial/ethnic besides international difference in the epidemiology of diabetic kidney disease which could be explained by the differences in economic viability and governmental infrastructures. […] Approximately one-third of diabetic patients showed microalbuminuria after 15 years of disease duration and less than half develop real nephropathy. […] Diabetic kidney disease (DKD) is more frequent in African-Americans, Asian-Americans, and Native Americans.

• #32 JMIR Public Health and Surveillance – Prevalence and Risk Factors of Chronic Kidney Disease in Patients With Type 2 Diabetes in China: Cross-Sectional Study

  https://publichealth.jmir.org/2024/1/e54429

  Chronic kidney disease (CKD) has emerged as a prominent long-term complication of diabetes, affecting approximately 30% of patients with type 1 diabetes and 40% of those with type 2 diabetes. […] A national study from December 2021 to September 2022 enlisted 9672 participants with type 2 diabetes from 45 hospitals that had endocrinology departments. The prevalence, screening, and awareness rates of CKD among patients with type 2 diabetes were 31% (2997/9672), 27% (810/2997), and 54.8% (5295/9672), respectively. […] The rising incidence of diabetes correlates with an increase in ESKD cases, with approximately 50% attributed to diabetes-related CKD in high-income nations. […] The factors associated with CKD in the univariate analyses included awareness; age; duration of diabetes; concurrent use of antihypertensive drugs, lipid regulators, antiplatelet agents, and microcirculation-improving agents; absence of concomitant drug use, except hypoglycemic agents; BMI; hypertension; elevated LDL-C and poor glycemic control; and diabetic foot, diabetic retinopathy, diabetic neuropathy, diabetic lower extremity arteriopathy, and cardiovascular disease. […] This cross-sectional study underscored a concerning 31% prevalence of CKD and notably low rates of CKD screening and awareness among adult Chinese patients with type 2 diabetes.

• #33 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  The incidence of DKD as a cause of ESKD is increasing each year. […] The prevalence of diabetes around the world has reached epidemic proportions. […] It has been estimated that more than 40% of people with diabetes will develop chronic kidney disease (CKD), including a significant number who will develop ESKD requiring renal replacement therapies (dialysis and or transplantation). […] There is marked racial/ethnic and international difference in the epidemiology of DKD. […] Native Americans, Hispanics and African-Americans have a much greater risk of developing ESKD than non-Hispanic whites with type 2 diabetes. […] Based on 2002 US data, diabetes is the cause of renal disease in 44% to 45% of incident ESKD cases, making the US rate one of the highest worldwide. […] Internationally, considerable variability among countries, with percentages fluctuating from nine percent in Russia to forty nine percent in Malaysia.

• #34 The Epidemiology of Diabetic Kidney Disease

  https://www.mdpi.com/2673-8236/2/3/38

  Diabetic kidney disease (DKD) is a frequent long-term complication of diabetes. Globally, DKD is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), accounting for 50% of cases. Approximately 20–50% of patients with T2DM will ultimately develop DKD. The kidney is an important target of microvascular damage in diabetes. Diabetic patients have twice the risk of CKD as those without diabetes. Diabetic kidney disease develops in nearly half of patients with T2DM and one-third of those with T1DM during their lifetime. It is one of the most frequent, burdensome, and expensive long-term complications of diabetes. The percentage of patients who have CKD caused by diabetes is not precisely known, since people with diabetes may have other causes of CKD in addition to diabetes. The prevalence of CKD, especially the earlier stages, is higher in women, but men are more likely to progress to ESKD for which KRT is needed. The largest treatment gaps were noted in low-income countries, particularly in Asia and Africa, where 1.9 and 0.4 million people were needing, but not receiving KRT. Worldwide, the prevalence of KRT is projected to more than double to 5.4 million people by 2030, with the most growth in Asia. In patients with T2DM the prevalence of CKD varies in countries across the world, ranging from 27% in China to 84% in Tanzania. The global epidemiology of T2DM is changing from a chronic disease in middle aged and older people, into one that is increasingly common at younger ages, including in young adults, adolescents, and children. The course of DKD is heterogeneous, owing to its different underlying causes. DKD has emerged as a major consequence of the global diabetes pandemic, largely driven by obesity. Therefore, diabetes and obesity prevention are the cornerstones of reducing the burden of DKD. Identification of DKD depends on screening for increased albuminuria and low kidney function.

• #35 Prevalence and predictors of chronic kidney disease among type 2 diabetic patients worldwide, systematic review and meta-analysis | Diabetology & Metabolic Syndrome | Full Text

  https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-023-01202-x

  CKD is estimated to affect 50% patients with T2DM globally, and its presence and severity markedly influences disease prognosis. […] The incident cases of CKD as a result of type 2 diabetes mellitus worldwide in 2017 had increased by 74% compared with 1990. […] Diabetes is the leading cause of CKD in all developed and most developing countries, with approximately 20% of people with type 2 diabetes showing evidence of diabetic nephropathy within 20 years of diabetes onset. […] Studies showed that early detection and treatment of diabetes and chronic diseases can slow or prevent the progression of CKD. […] The study revealed that being old age, hypertension, cardiac disease, smoking, obesity, having type 2 diabetes mellitus was predictor variable for presence of chronic kidney disease among type 2 diabetic patients.

• #36 The burden of diabetic nephropathy in India: Need for prevention

  https://www.degruyterbrill.com/document/doi/10.2478/dine-2023-0003/html?lang=en&srsltid=AfmBOorCot2goeM6WFgJykZVBsQ8RZVgvGlCTvyt15od-ynHLKvbYUWC

  Diabetic nephropathy (DN) is a growing public health problem with a high economic burden. DN is the main cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD). […] The worldwide prevalence of DN can be attributed to the substantial increase in the incidence of diabetes worldwide. According to the IDF 2021, the number of people affected worldwide has increased by 46.0% to approximately 783 million, placing a great socioeconomic burden on patients, healthcare professionals, and the nation. In India, the prevalence of DN ranges from 0.9% to 62.3%. […] The prevalence of microalbuminuria in patients with a duration of diabetes 1 year was 24.7% and that of proteinuria was 6.2%. […] In India, approximately 170,000-250,000 new patients may need renal replacement therapy yearly. The prevalence is estimated to be approximately 55,000 and grows by approximately 10% annually.

• #37 The Epidemiology of Diabetic Kidney Disease

  https://www.mdpi.com/2673-8236/2/3/38

  Diabetic kidney disease (DKD) is a frequent long-term complication of diabetes. Globally, DKD is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), accounting for 50% of cases. Approximately 20–50% of patients with T2DM will ultimately develop DKD. The kidney is an important target of microvascular damage in diabetes. Diabetic patients have twice the risk of CKD as those without diabetes. Diabetic kidney disease develops in nearly half of patients with T2DM and one-third of those with T1DM during their lifetime. It is one of the most frequent, burdensome, and expensive long-term complications of diabetes. The percentage of patients who have CKD caused by diabetes is not precisely known, since people with diabetes may have other causes of CKD in addition to diabetes. The prevalence of CKD, especially the earlier stages, is higher in women, but men are more likely to progress to ESKD for which KRT is needed. The largest treatment gaps were noted in low-income countries, particularly in Asia and Africa, where 1.9 and 0.4 million people were needing, but not receiving KRT. Worldwide, the prevalence of KRT is projected to more than double to 5.4 million people by 2030, with the most growth in Asia. In patients with T2DM the prevalence of CKD varies in countries across the world, ranging from 27% in China to 84% in Tanzania. The global epidemiology of T2DM is changing from a chronic disease in middle aged and older people, into one that is increasingly common at younger ages, including in young adults, adolescents, and children. The course of DKD is heterogeneous, owing to its different underlying causes. DKD has emerged as a major consequence of the global diabetes pandemic, largely driven by obesity. Therefore, diabetes and obesity prevention are the cornerstones of reducing the burden of DKD. Identification of DKD depends on screening for increased albuminuria and low kidney function.

• #38 The Epidemiology of Diabetic Kidney Disease

  https://www.mdpi.com/2673-8236/2/3/38

  Diabetic kidney disease (DKD) is a frequent long-term complication of diabetes. Globally, DKD is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), accounting for 50% of cases. Approximately 20–50% of patients with T2DM will ultimately develop DKD. The kidney is an important target of microvascular damage in diabetes. Diabetic patients have twice the risk of CKD as those without diabetes. Diabetic kidney disease develops in nearly half of patients with T2DM and one-third of those with T1DM during their lifetime. It is one of the most frequent, burdensome, and expensive long-term complications of diabetes. The percentage of patients who have CKD caused by diabetes is not precisely known, since people with diabetes may have other causes of CKD in addition to diabetes. The prevalence of CKD, especially the earlier stages, is higher in women, but men are more likely to progress to ESKD for which KRT is needed. The largest treatment gaps were noted in low-income countries, particularly in Asia and Africa, where 1.9 and 0.4 million people were needing, but not receiving KRT. Worldwide, the prevalence of KRT is projected to more than double to 5.4 million people by 2030, with the most growth in Asia. In patients with T2DM the prevalence of CKD varies in countries across the world, ranging from 27% in China to 84% in Tanzania. The global epidemiology of T2DM is changing from a chronic disease in middle aged and older people, into one that is increasingly common at younger ages, including in young adults, adolescents, and children. The course of DKD is heterogeneous, owing to its different underlying causes. DKD has emerged as a major consequence of the global diabetes pandemic, largely driven by obesity. Therefore, diabetes and obesity prevention are the cornerstones of reducing the burden of DKD. Identification of DKD depends on screening for increased albuminuria and low kidney function.

• #39

  https://journals.lww.com/cjasn/fulltext/2017/12000/diabetic_kidney_disease__challenges,_progress,_and.17.aspx

  The paradigm of the natural history of DKD continues to evolve. […] Deaths due to CVDs and infections are highly prevalent and compete with progression to ESRD. […] The clinical diagnosis of DKD is on the basis of measurement of eGFR and albuminuria along with clinical features, such as diabetes duration and presence of diabetic retinopathy. […] Despite current approaches to management of diabetes and hypertension and use of ACE inhibitors and ARB, there is still large residual risk in DKD. […] Success of this strategy has been shown by recently available data from the Centers for Disease Control.

• #40 Estimation of chronic kidney disease among diabetic patients using the CKD-EPI equation

  https://www.acquaintpublications.com/article/estimation_of_chronic_kidney_disease_among_diabetic_patients_using_the_ckd_epi_equation34

  Estimation of chronic kidney disease among diabetic patients using the CKD-EPI equation. […] One of the most serious chronic microvascular consequences of diabetes is diabetic nephropathy (DN), which has also been linked to hypertension and DN as the main causes of end-stage renal disease (ESRD). […] A large majority of patients with diabetic kidney disease DKD will die from cardiovascular disease before they reach ESRD, and it causes mortality in people with diabetic kidney disease to be about 30 times higher than that in diabetic patients without nephropathy. […] By measuring GFR using the CKD-EPI creatinine equation, DN in patients with diabetes and diabetic hypertensive is measured. […] According to the CKD EPI equation, eGFR, of the total of 145 participants (63.4 %) female and (36.6 %) male, 85 (58.6 %) participants have normal/ high stage 1 CKD, 48(33.1 %) with mildly decreased kidney function stage 2, (4.8 %) mildly to moderately decrease in kidney function stage 3a, 4 (1.4 %) were in stage 3b moderately to severely decreased kidney function, 2 (1.4 %) severely decreased kidney function and 1(0.7 %) with ESRD.

• #41 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). […] Diabetic kidney disease (DKD) affects about 20% of patients with diabetes. […] DKD is associated with increased risks of morbidity and mortality and is the leading cause of end-stage renal disease (ESRD) in the United States. […] Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion. […] Prevention of diabetes in the general population is the most effective means of minimizing the impact of DKD; understanding risk factors for DKD development can help with early identification and intervention. […] Screening for microalbuminuria can be completed in three ways: 24-hour collection with creatinine, allowing for simultaneous measurement of creatinine clearance; timed (four-hour or overnight) collection; or measurement of the albumin/creatinine ratio in a random spot collection.

• #42 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). […] Diabetic kidney disease (DKD) affects about 20% of patients with diabetes. […] DKD is associated with increased risks of morbidity and mortality and is the leading cause of end-stage renal disease (ESRD) in the United States. […] Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion. […] Prevention of diabetes in the general population is the most effective means of minimizing the impact of DKD; understanding risk factors for DKD development can help with early identification and intervention. […] Screening for microalbuminuria can be completed in three ways: 24-hour collection with creatinine, allowing for simultaneous measurement of creatinine clearance; timed (four-hour or overnight) collection; or measurement of the albumin/creatinine ratio in a random spot collection.

• #43 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). […] Diabetic kidney disease (DKD) affects about 20% of patients with diabetes. […] DKD is associated with increased risks of morbidity and mortality and is the leading cause of end-stage renal disease (ESRD) in the United States. […] Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion. […] Prevention of diabetes in the general population is the most effective means of minimizing the impact of DKD; understanding risk factors for DKD development can help with early identification and intervention. […] Screening for microalbuminuria can be completed in three ways: 24-hour collection with creatinine, allowing for simultaneous measurement of creatinine clearance; timed (four-hour or overnight) collection; or measurement of the albumin/creatinine ratio in a random spot collection.

• #44 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter29

  All individuals with chronic kidney disease should be considered at high risk for cardiovascular events and should be treated to reduce these risks. […] The development and progression of renal damage in diabetes can be reduced and slowed through intensive glycemic control and optimization of blood pressure. Progression of chronic kidney disease in diabetes can also be slowed through the use of medications that disrupt the renin angiotensin aldosterone system. […] Screening for CKD in people with diabetes involves an assessment of urinary albumin excretion and a measurement of the overall level of kidney function through an eGFR. […] People with type 1 diabetes are not expected to have kidney disease at the time of onset of diabetes, so screening can be delayed until the duration of diabetes exceeds 5 years.

• #45 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter29

  Significant renal disease can be present at the time of diagnosis of type 2 diabetes (26,27), so screening should be initiated immediately at the time of diagnosis in this group. […] Diabetic nephropathy is a major cause of CKD in diabetes; however, people with diabetes can also get CKD from other causes, including hypertensive nephrosclerosis or ischemic nephropathy from atherosclerotic changes to small or large renal arteries. […] Clinical studies have suggested that one-quarter to one-half of people with diabetes and significant kidney function impairment do not have albuminuria (1820). […] These studies suggest that testing for albuminuria may be insufficient in identifying all people with diabetes who have renal disease. […] In addition to measurements of urinary albumin excretion, estimations of the level of kidney function and urinalyses are required to identify people with kidney disease other than diabetic nephropathy.

• #46 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter29

  The classical description of diabetic nephropathy is a slow and progressive increase in albuminuria, followed later in the disease by a decrease in estimated glomerular filtration rate (eGFR) below 60mL/min/1.73m2, which can, eventually, lead to end stage renal disease (ESRD) (1,9,10) (Figure 2). […] Diabetes is the leading cause of kidney disease in Canada (4). […] A variety of forms of chronic kidney disease (CKD) in diabetes can be seen, including diabetic nephropathy, ischemic nephropathy related to vascular disease, hypertensive nephrosclerosis, as well as other renal diseases that are unrelated to diabetes (7,8) (Figure 1). […] Identification of chronic kidney disease in people with diabetes requires screening for proteinuria, as well as an assessment of serum creatinine converted into an estimated glomerular function rate (eGFR).

• #47

  https://journals.lww.com/cjasn/fulltext/2017/12000/diabetic_kidney_disease__challenges,_progress,_and.17.aspx

  The paradigm of the natural history of DKD continues to evolve. […] Deaths due to CVDs and infections are highly prevalent and compete with progression to ESRD. […] The clinical diagnosis of DKD is on the basis of measurement of eGFR and albuminuria along with clinical features, such as diabetes duration and presence of diabetic retinopathy. […] Despite current approaches to management of diabetes and hypertension and use of ACE inhibitors and ARB, there is still large residual risk in DKD. […] Success of this strategy has been shown by recently available data from the Centers for Disease Control.

• #48 Diabetic nephropathy – complications and treatment | IJNRD

  https://www.dovepress.com/diabetic-nephropathy-ndash-complications-and-treatment-peer-reviewed-fulltext-article-IJNRD

  The natural history depends on the type of diabetes. […] Patients who progress to macroalbuminuria are more likely to develop ESRD. […] Screening begins at diagnosis of type 2 diabetes and usually 5 years after onset of type 1 diabetes. […] The routine use of renal biopsy to confirm DN is much debated. […] The prevalence of specific disease in the population can also affect the biopsy decision. […] There are limitations in using albuminuria as a marker of DN as many patients experience GFR loss without deterioration in albuminuria. […] The most promising biomarker currently is serum TNF- receptor levels, which may predict progression of CKD and ESRD, in type 1 and type 2 diabetics. […] Understanding the pathophysiology of DN has improved over the years, particularly the molecular biology aspect. […] Inflammation has emerged as an important theme, while treatment targets and options continue to evolve as knowledge improves. […] Despite these challenges, new strategies to complement existing treatments will nonetheless continue to be looked for.

• #49 Diabetic nephropathy – complications and treatment | IJNRD

  https://www.dovepress.com/diabetic-nephropathy-ndash-complications-and-treatment-peer-reviewed-fulltext-article-IJNRD

  The natural history depends on the type of diabetes. […] Patients who progress to macroalbuminuria are more likely to develop ESRD. […] Screening begins at diagnosis of type 2 diabetes and usually 5 years after onset of type 1 diabetes. […] The routine use of renal biopsy to confirm DN is much debated. […] The prevalence of specific disease in the population can also affect the biopsy decision. […] There are limitations in using albuminuria as a marker of DN as many patients experience GFR loss without deterioration in albuminuria. […] The most promising biomarker currently is serum TNF- receptor levels, which may predict progression of CKD and ESRD, in type 1 and type 2 diabetics. […] Understanding the pathophysiology of DN has improved over the years, particularly the molecular biology aspect. […] Inflammation has emerged as an important theme, while treatment targets and options continue to evolve as knowledge improves. […] Despite these challenges, new strategies to complement existing treatments will nonetheless continue to be looked for.

• #50 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter29

  Significant renal disease can be present at the time of diagnosis of type 2 diabetes (26,27), so screening should be initiated immediately at the time of diagnosis in this group. […] Diabetic nephropathy is a major cause of CKD in diabetes; however, people with diabetes can also get CKD from other causes, including hypertensive nephrosclerosis or ischemic nephropathy from atherosclerotic changes to small or large renal arteries. […] Clinical studies have suggested that one-quarter to one-half of people with diabetes and significant kidney function impairment do not have albuminuria (1820). […] These studies suggest that testing for albuminuria may be insufficient in identifying all people with diabetes who have renal disease. […] In addition to measurements of urinary albumin excretion, estimations of the level of kidney function and urinalyses are required to identify people with kidney disease other than diabetic nephropathy.

• #51 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Diagnosis is made clinically when a patient has evidence of kidney disease and no other primary etiology. Early referral to nephrology (at chronic kidney disease stage 3 or 4) may help improve DKD outcomes and should be considered. […] Identification of patients with microalbuminuria allows for timely initiation of treatment to prevent disease progression and to reduce the risk of ESRD. […] Blood pressure (BP) control is critical to prevent and slow the progression of DKD. […] Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) delay and reduce the progression of DKD. […] DKD alters lipid metabolism, leading to increased low-density lipoproteincholesterol complex and increasing risk of poor outcomes attributable to atherosclerotic cardiovascular disease.

• #52

  https://link.springer.com/article/10.1007/s10157-020-01881-0

  Patients with diabetic kidney disease are believed to develop proteinuria prior to renal function loss. […] This classical belief, however, has been recently disputed by growing evidence that a substantial proportion of patients either with type 1 diabetes or type 2 diabetes have renal function loss in the absence of proteinuria, known as nonproteinuric diabetic kidney disease. […] This phenotype of diabetic kidney disease suggests that there is a dissociation between renal function and level of albuminuria in patients with diabetes and highlight the need for broader understanding of renal function loss apart from those related to an increase in albuminuria. […] In this review, we discuss ever known epidemiology, pathology, renal prognosis, and mortality of nonproteinuric diabetic kidney disease, comparing with those of proteinuric diabetic kidney disease.

• #53 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Striking epidemiologic differences exist even among European countries. In some European countries, particularly Germany, the proportion of patients admitted for renal replacement therapy exceeds the figures reported from the United States. […] A study from the Netherlands suggested that diabetic nephropathy is underdiagnosed. Using renal tissue specimens from autopsies, Klessens et al found histopathologic changes associated with diabetic nephropathy in 106 of 168 patients with type 1 or type 2 diabetes. […] A retrospective study from China, by Fan and Wang, indicated that in type 2 diabetes patients with renal injury, there is a high prevalence of nondiabetic renal disease (NDRD). […] Diabetic nephropathy affects males and females equally. […] Diabetic nephropathy rarely develops before 10 years duration of type 1 DM. The peak incidence (3%/y) is usually found in persons who have had diabetes for 10-20 years.

• #54 Prevalence of non-diabetic kidney disease and inability of clinical predictors to differentiate it from diabetic kidney disease: results from a prospectively performed renal biopsy study | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/10/6/e003058

  The prevalence of DKD was 66.4%, and that of NDKD was 18.2%. The prevalence of mixed kidney disease was 15.4%. This highlights the huge burden of NDKD either in isolation or in combination with DKD (ie, mixed kidney disease group) among subjects with T2DM and kidney involvement who might benefit from renal biopsy. […] NDKD is very common among subjects with T2DM and renal involvement. Currently used predictors to preselect biopsy for detecting NDKD have limited value at making clinical decisions at individual patient level.

• #55 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter29

  The classical description of diabetic nephropathy is a slow and progressive increase in albuminuria, followed later in the disease by a decrease in estimated glomerular filtration rate (eGFR) below 60mL/min/1.73m2, which can, eventually, lead to end stage renal disease (ESRD) (1,9,10) (Figure 2). […] Diabetes is the leading cause of kidney disease in Canada (4). […] A variety of forms of chronic kidney disease (CKD) in diabetes can be seen, including diabetic nephropathy, ischemic nephropathy related to vascular disease, hypertensive nephrosclerosis, as well as other renal diseases that are unrelated to diabetes (7,8) (Figure 1). […] Identification of chronic kidney disease in people with diabetes requires screening for proteinuria, as well as an assessment of serum creatinine converted into an estimated glomerular function rate (eGFR).

• #56 The Epidemiology of Diabetic Kidney Disease

  https://www.mdpi.com/2673-8236/2/3/38

  Diabetic kidney disease (DKD) is a frequent long-term complication of diabetes. Globally, DKD is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), accounting for 50% of cases. Approximately 20–50% of patients with T2DM will ultimately develop DKD. The kidney is an important target of microvascular damage in diabetes. Diabetic patients have twice the risk of CKD as those without diabetes. Diabetic kidney disease develops in nearly half of patients with T2DM and one-third of those with T1DM during their lifetime. It is one of the most frequent, burdensome, and expensive long-term complications of diabetes. The percentage of patients who have CKD caused by diabetes is not precisely known, since people with diabetes may have other causes of CKD in addition to diabetes. The prevalence of CKD, especially the earlier stages, is higher in women, but men are more likely to progress to ESKD for which KRT is needed. The largest treatment gaps were noted in low-income countries, particularly in Asia and Africa, where 1.9 and 0.4 million people were needing, but not receiving KRT. Worldwide, the prevalence of KRT is projected to more than double to 5.4 million people by 2030, with the most growth in Asia. In patients with T2DM the prevalence of CKD varies in countries across the world, ranging from 27% in China to 84% in Tanzania. The global epidemiology of T2DM is changing from a chronic disease in middle aged and older people, into one that is increasingly common at younger ages, including in young adults, adolescents, and children. The course of DKD is heterogeneous, owing to its different underlying causes. DKD has emerged as a major consequence of the global diabetes pandemic, largely driven by obesity. Therefore, diabetes and obesity prevention are the cornerstones of reducing the burden of DKD. Identification of DKD depends on screening for increased albuminuria and low kidney function.

• #57 Diabetic kidney disease: world wide difference of prevalence and risk factors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5297507/

  The incidence of DKD as a cause of ESKD is increasing each year. […] The prevalence of diabetes around the world has reached epidemic proportions. […] It has been estimated that more than 40% of people with diabetes will develop chronic kidney disease (CKD), including a significant number who will develop ESKD requiring renal replacement therapies (dialysis and or transplantation). […] There is marked racial/ethnic and international difference in the epidemiology of DKD. […] Native Americans, Hispanics and African-Americans have a much greater risk of developing ESKD than non-Hispanic whites with type 2 diabetes. […] Based on 2002 US data, diabetes is the cause of renal disease in 44% to 45% of incident ESKD cases, making the US rate one of the highest worldwide. […] Internationally, considerable variability among countries, with percentages fluctuating from nine percent in Russia to forty nine percent in Malaysia.

• #58 Diabetic Kidney Disease: From Epidemiology to Clinical Perspectives

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2014.38.4.252

  It is evident that the progression of renal failure continues in DKD despite tight and early glucose control, tight blood pressure control as well as aggressive renin-angiotensin-aldosterone (RAA) blockade. […] Diabetic nephropathy is associated with an increased risk of CKD, which is characterized by albuminuria or reduced eGFR. […] Estimates of the prevalence of DKD vary widely. It ranges from 10% to 40% for both type 1 and type 2 diabetes patient groups depending on the definition of the disease used. […] The prevalence of CKD in patients with type 2 diabetes in the KNHANES V was 8.6% which is much lower than that in Western populations as well as in other East Asian populations. […] The most common primary cause of ESRD in 2012 was diabetic nephropathy (50.6%) followed by hypertensive nephrosclerosis (18.5%) and chronic glomerulonephritis (8.1%).

• #59 Diabetic kidney disease in patients with type 2 diabetes mellitus: a cross-sectional study | BMC Nephrology | Full Text

  https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-021-02429-4

  We found that 701 (50.14%) patients had DKD, 625 (44.7%) had albuminuria, and 268 (19.17%) had CKD with an eGFR of 60 mL/min/1.73 m2. […] The prevalence of DKD was related to age, ranging from 46% in patients aged 60 to 52.8% in those aged 60 years. […] DKD was also associated retinopathy and neuropathy. […] Our results showed that patients who reported using metformin or RAAS blocker had a lower risk of developing DKD and proteinuria. […] The prevalence of DKD increases with age and is more evident by a low eGFR than by albuminuria. […] We found that more than half of the patients with DM type 2 had DKD with approximately one-third were at moderate risk of major adverse events. […] DKD was correlated to older age, longer duration of diabetes, the presence of diabetic complications, and dyslipidemia. […] Albuminuria adds valuable information regarding the prevalence, epidemiological characteristics, and risk factors of DKD.

• #60 Prevalence and determinants of chronic kidney disease among patients with type 2 diabetes followed in a sub-Saharan resource-limited setting during COVID-19 pandemic (case of Dschang District Dospital) – Simeni Njonnou – Journal of Xiangya Medicine

  https://jxym.amegroups.org/article/view/9675/html

  Its progress must be monitored very frequently. […] Appropriate management of diabetes and its comorbidities is necessary for the prevention and progression control of these abnormalities. […] The prevalence of CKD among patients with diabetes ranges from 11% to 90% with a pooled prevalence of 24.7% (95% CI: 23.625.7%) and, can evolve into end-stage renal disease (ESRD). […] Diabetic nephropathy is the leading cause of CKD in patients with diabetes. […] In Cameroon, Kaze et al. found a CKD prevalence respectively of 10% in Douala, 11.7% in Garoua and 13.2% in Dschang; with patients with diabetes accounting for 40% of those with ESRD. […] Based on all of the above, we found it necessary to assess the prevalence and determinants of CKD among sub-Saharan patients with diabetes in rural area.

• #61 Diabetic nephropathy – complications and treatment | IJNRD

  https://www.dovepress.com/diabetic-nephropathy-ndash-complications-and-treatment-peer-reviewed-fulltext-article-IJNRD

  Diabetic nephropathy is a significant cause of chronic kidney disease and end-stage renal failure globally. […] The diabetes epidemic has resulted in DN becoming the most frequent cause of end-stage renal disease (ESRD) in most countries. […] In 2009-2011, diabetes was the primary cause of ESRD in about 60% of patients in Malaysia, Mexico, and Singapore. […] The incidence of ESRD due to diabetes also rises in the older age group. […] Thus, the reason for this boom in diabetes-associated ESRD is the increasing prevalence of diabetes and the aging population. […] The main modifiable risks are hypertension, glycemic control, and dyslipidemia. […] Not all diabetics develop DN and in those who do, progression is variable. […] A meta-analysis of studies identified 24 genetic variants in 16 genes which are associated with DN.

• #62

  https://www.who.int/news-room/fact-sheets/detail/diabetes

  In 2021, diabetes and kidney disease due to diabetes caused over 2 million deaths. […] Another 530 000 kidney disease deaths were caused by diabetes, and high blood glucose causes around 11% of cardiovascular deaths. […] People with diabetes have a higher risk of health problems including heart attack, stroke and kidney failure. […] Additional medical care may be needed to treat the effects of diabetes: screening and treatment for kidney disease. […] WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low- and middle-income countries. […] WHO conducts surveillance of diabetes and its risk factors.

• #63

  https://www.who.int/news-room/fact-sheets/detail/diabetes

  In 2021, diabetes and kidney disease due to diabetes caused over 2 million deaths. […] Another 530 000 kidney disease deaths were caused by diabetes, and high blood glucose causes around 11% of cardiovascular deaths. […] People with diabetes have a higher risk of health problems including heart attack, stroke and kidney failure. […] Additional medical care may be needed to treat the effects of diabetes: screening and treatment for kidney disease. […] WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low- and middle-income countries. […] WHO conducts surveillance of diabetes and its risk factors.

• #64 Epidemiology and Classification of Chronic Kidney Disease and Management of Diabetic Nephropathy – touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/epidemiology-and-classification-of-chronic-kidney-disease-and-management-of-diabetic-nephropathy-2/

  The incidence of diabetes has reached epidemic proportions throughout the world, with an expected doubling in the number of patients with type 2 diabetes in the next 25 years. This, in turn, will lead to an increased incidence of diabetic nephropathy, with approximately 30% progressing to stage 5 CKD. […] In the UK, diabetic nephropathy accounts for 18% of new patients commencing renal replacement therapy and makes up 11% of the prevalent patient population. This is not solely a UK phenomenon; in 2002, Australia reported that the country accepted 94pmp for RRT, of which 26% were diabetics. In Pakistan, the incidence of diabetics entering the programme is 42%, in Japan 37% and in the US 14.8%. This is a worldwide problem that needs to be addressed. […] The majority of the CKD population have one or more co-morbid condition with a known higher prevalence in ethnic minorities and lower socioeconomic groups. Without effective prevention and early detection programmes, the incidence rate of CKD will continue to rise. Early detection and referral of CKD patients to nephrology teams is pivotal to slowing the progression to ESRD and reducing the demand for dialysis. Diabetic nephropathy progression can be slowed by effectively tightening glycaemic control, lowering blood pressure to a minimum of 130/75mmHg with ACE inhibitors or ARBs, lowering cholesterol and educating patients on how to lead a healthy lifestyle. The World Health Organization (WHO) has set a goal to reduce chronic disease mortality by 2% a year for the next decade and, therefore, more emphasis needs to be placed on prevention of CKD and the need for RRT in this patient population.

• #65 Diabetic Kidney Disease: From Epidemiology to Clinical Perspectives

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2014.38.4.252

  Since the proportion of diabetes and prediabetes has largely increased, the complications of diabetes including DKD will be increasing significantly as well. […] The principal goals of the health care system should focus on the prevention and slowing of progression of CKD resulting from diabetes and health-care providers including nephrologists and endocrinologists are required to determine the best approach for both diagnosis and management. […] Furthermore, research into novel therapies to treat diabetic nephropathy is an urgent need aiming at the prevention and management of DKD and this should be preceded by appropriate understanding of the prevalence and the nature of diabetic nephropathy.

• #66 Chronic Kidney Disease (CKD): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238798-overview

  The adjusted incidence of end-stage kidney disease (ESKD) in the US fell by 8.9% from 2000 to 2019. Over that period, however, the number of patients with newly registered ESKD rose from 97,856 to 134,837, an increase of 37.8%. […] In 2023, more than 808,000 people in the US (2 per 1000 population) were currently living with ESKD. […] The US Surgeon General’s latest report on 10-year national objectives for improving the health of all Americans, Healthy People 2030, contains a chapter focused on CKD. For 2030, Healthy People lays out 14 objectives concerning reduction of the US incidence, morbidity, mortality, and health costs of CKD. Reducing kidney failure will require additional public health efforts, including effective preventive strategies and early detection and treatment of CKD.

• #67 Current Challenges in Diabetic Nephropathy: Early Diagnosis and Ways to Improve Outcomes

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2016.31.2.245

  The current KDIGO guidelines recommend that both albuminuria and GFR be monitored annually. More frequent measurements of eGFR and albuminuria should be considered in patients with a lower GFR and a higher albuminuria level because these conditions are more likely to progress in such patients. […] There is increasing evidence that both albuminuria and eGFR categories are valuable. Increased albuminuria and decreased GFR are both associated with an increased risk of CKD and are synergistic. […] The American Diabetes Association (ADA) recommends that a patient is considered to have albuminuria when at least two of three measurements of urine ACR examined within 6 months are abnormal. […] The rate of progression from category A2 to category A3 is predicted to be 2% to 3% per year, and this progression is associated with a decrease in glomerular filtration rate (GFR).

• #68 Current Challenges in Diabetic Nephropathy: Early Diagnosis and Ways to Improve Outcomes

  https://www.e-enm.org/journal/view.php?doi=10.3803/enm.2016.31.2.245

  The current KDIGO guidelines recommend that both albuminuria and GFR be monitored annually. More frequent measurements of eGFR and albuminuria should be considered in patients with a lower GFR and a higher albuminuria level because these conditions are more likely to progress in such patients. […] There is increasing evidence that both albuminuria and eGFR categories are valuable. Increased albuminuria and decreased GFR are both associated with an increased risk of CKD and are synergistic. […] The American Diabetes Association (ADA) recommends that a patient is considered to have albuminuria when at least two of three measurements of urine ACR examined within 6 months are abnormal. […] The rate of progression from category A2 to category A3 is predicted to be 2% to 3% per year, and this progression is associated with a decrease in glomerular filtration rate (GFR).

• #69 The Concept and the Epidemiology of Diabetic Nephropathy Have Changed in Recent Years

  https://www.mdpi.com/2077-0383/4/6/1207

  Despite the growing DM population, a slowdown in DKD progression seems to be evident. Early detection of both DM and DKD are crucial to reduce complications, morbidity and mortality as well as the social and economic impact of DM burden in this population. It is also crucial to improve the survival of these patients once they are under RRT.

• #70

  https://journals.lww.com/cjasn/fulltext/2017/12000/diabetic_kidney_disease__challenges,_progress,_and.17.aspx

  The paradigm of the natural history of DKD continues to evolve. […] Deaths due to CVDs and infections are highly prevalent and compete with progression to ESRD. […] The clinical diagnosis of DKD is on the basis of measurement of eGFR and albuminuria along with clinical features, such as diabetes duration and presence of diabetic retinopathy. […] Despite current approaches to management of diabetes and hypertension and use of ACE inhibitors and ARB, there is still large residual risk in DKD. […] Success of this strategy has been shown by recently available data from the Centers for Disease Control.

• #71 The Concept and the Epidemiology of Diabetic Nephropathy Have Changed in Recent Years

  https://www.mdpi.com/2077-0383/4/6/1207

  Diabetes Mellitus (DM) is a growing worldwide epidemic. It was estimated that more than 366 million people would be affected. DM has spread its presence over the world due to lifestyle changes, increasing obesity and ethnicities, among others. Diabetic nephropathy (DN) is one of the most important DM complications. A changing concept has been introduced from the classical DN to diabetic chronic kidney disease (DCKD), taking into account that histological kidney lesions may vary from the nodular or diffuse glomerulosclerosis to tubulointerstitial and/or vascular lesions. Recent data showed how primary and secondary prevention were the key to reduce cardiovascular episodes and improve life expectancy in diabetic patients. A stabilization in the rate of end stage kidney disease has been observed in some countries, probably due to the increased awareness by primary care physicians about the prognostic importance of chronic kidney disease (CKD), better control of blood pressure and glycaemia and the implementation of protocols and clinical practice recommendations about the detection, prevention and treatment of CKD in a coordinated and multidisciplinary management of the DM patient. Early detection of DM and DCKD is crucial to reduce morbidity, mortality and the social and economic impact of DM burden in this population.

• #72 The Concept and the Epidemiology of Diabetic Nephropathy Have Changed in Recent Years

  https://www.mdpi.com/2077-0383/4/6/1207

  In 2005, we estimated around 33,000 type 1 and 405,000 type 2 diabetic patients with some form of DN, from microalbuminuria to ERSD in Spain. […] In 2013, our group also published the results from Catalonia, Spain. They showed a decrease from 6456 per million population (p.m.p.) in 2002 to 600 p.m.p. in 2010 in ESRD (7% reduction of adjusted rate). Data from the Spanish Society of Nephrology (S.E.N.), recorded in the annual renal registry, also showed a stabilization of DM as a cause of CKD requiring renal replacement therapy (RRT) in the last four years (incidence: 24.97% in 2011, 24.91% in 2012, 24.90% in 2012 and 24.71% in 2013 and rate p.m.p: 31.6 in 2010, 32.1 in 2011, 32.9 in 2012 and 31.9 in 2013). Although DM continuous to be the first cause of ESRD in Spain—as in the whole world—we have observed a clear stabilization of ESRD due to DM compared to other causes of CKD-5.

Zobacz więcej