Going in Early: Hypoxia as a Target for Kidney Disease Prevention in Diabetes?

Abstract

Diabetic kidney disease (DKD) begins early, which is pertinent to those diagnosed with diabetes during childhood and adolescence. The initiators of DKD are not fully defined, but hypoxia and metabolic abnormalities are important. With growing numbers of young people diagnosed with diabetes and concomitant risk for early mortality, this commentary examines the study by Vinovskis et al. (1) in this issue of Diabetes , which highlights renal hypoxia as an early phenomenon in diabetes associated with risk for DKD. Many diabetologists and nephrologists consider DKD an affliction of late-middle age. Certainly, the proportion of affected individuals with diabetes escalates with age (2), and at least one-third of these will develop DKD, a major risk factor for cardiovascular disease and early mortality (3). Global estimates of people living with diabetes have tripled in the past 20 years (2), topping 463 million individuals, suggesting that 167 million of these already have or will develop DKD. Perhaps less well known is the growing incidence of diabetes in children and adolescents, which is escalating by 3% each year, and at a higher rate in some ethnic groups (2). Another underappreciated fact is that many children and adolescents with diabetes develop complications in early adulthood, placing significant burden on the individual, the family, and society. Data from the International Diabetes Federation suggest that almost half (46.2%) of deaths associated with diabetes among the 20–79 years age-group are in people under the age of 60 years (2). Hence, because the average age of enrolment in phase 3 studies of diabetes-related mortality is 60 years of age, younger individuals who may have benefited from these interventions were excluded. Therefore, undertaking studies to understand and potentially intervene in early complications of diabetes in a much younger cohort than standard is crucial to potentially improving the outcomes of diabetes …