THE RISING TIDE OF END-STAGE RENAL-FAILURE FROM DIABETIC NEPHROPATHY TYPE-II - AN EPIDEMIOLOGIC ANALYSIS

In recent years there has been a substantial increase in the proportio n of patients requiring renal replacement therapy who suffer from diab etes mellitus. In the lower Neckar region, a survey has been made comp rising all patients admitted for renal replacement therapy from 1.1. 1 993-30.6.1994. Out of a total of 225 patients admitted, 95 suffered fr om diabetes (10 type I, 85 type II). The estimated annual incidence of terminal renal failure with diabetes was 52/mio/year. At the same tim e, 79 patients who suffered from diabetes were admitted to the renal u nit in Heidelberg (outpatient clinic and ward) for evaluation of de no vo renal failure (similar to 176/mio/year); standard primary chronic r enal disease was found in 19/79 of these diabetic patients (25%). The discrepancy between the annual incidence of (i) renal failure and of ( ii) terminal renal failure suggests that a high proportion of patients with diabetes (mainly type II) and renal failure, dies prior to reach ing terminal renal failure. Potential reasons for the increasing incid ence of endstage renal failure from diabetes type II are (i) the incre asing prevalence of type II diabetes in Germany in recent decades, (ii ) aging of the population in view of the known greater prevalence of t ype II diabetes in older individuals and (iii) improved survival of pa tients with type II diabetes secondary to diminished cardiovascular mo rtality. Particularly because of the latter factor a further increase of endstage renal failure in patients with type II diabetes must be an ticipated.