End-stage renal failure in type 2 diabetes: A medical catastrophe of worldwide dimensions

The incidence of patients with end-stage renal failure and diabetes mellitu s type 2 as a comorbid condition has increased progressively in the past de cades, first in the United States and Japan, but subsequently in all countr ies with a western lifestyle, Although there are explanations for this incr ease, the major factor is presumably diminishing mortality from hypertensio n and cardiovascular causes, so that patients survive long enough to develo p nephropathy and end-stage renal failure, This review summarizes the strik ing differences between countries against the background of a similar tende ncy of an increasing incidence in all countries. Survival on renal replacem ent therapy continues to be substantially worse for patients with type 2 di abetes, A major reason for this observation is that patients enter renal re placement programs with cardiovascular morbidity acquired in the pretermina l phase of renal failure, It is argued that the challenge for the future wi ll be better patient management in earlier phases of diabetic nephropathy t o attenuate or prevent progression, as well as cardiovascular complications , (C) 1999 by the National Kidney Foundation, Inc.