Diabetic nephropathy in patients with type II diabetes.

Abstract

Diabetic nephropathy is the single most common cause of end-stage renal disease (ESRD) in the United States. Patients with diabetes account for 35% of all those enrolled in the Medicare ESRD Program and, at current rates of increase, patients with diabetes will soon account for 50% of all ESRD patients [1]. Most of these patients have Type II diabetes and are elderly [2]. In 1992 the cost of caring for these patients’ renal disease alone exceeded 2 billion dollars per year in the United States [1]. Similarly, European registry data reveal a dramatic increase in the incidence of ESRD due to diabetic nephropathy [2]. In European renal replacement programs, the relative increase in acceptance rates has been considerably greater for patients classed as having Type II diabetes than for those with Type I diabetes. This dramatic increase in Type II diabetes and diabetic nephropathy in both Europe and the United States reflects the epidemic of Type II diabetes worldwide [4]. Also it may reflect the increased survival of patients with Type II diabetes and protein- uria. In Germany the survival rate, five years after the onset of proteinuria, for a patient with Type II diabetes was 35% in the period 1966 to 1975, but rose to 75% from 1976 to 1985 [5].