The incidence of end-stage renal disease [ESRD; stage 5 chronic kidney disease (CKD)] continues to increase in Europe, particularly due to type 2 diabetes, hypertensive renovascular disease or atherosclerosis [1–3]. Indeed, across nine European countries (Austria, Belgium, Denmark, Finland, Greece, Norway, Scotland, Spain and the Netherlands) from 1990 to 1999, the adjusted incidence of renal replacement therapy to treat ESRD increased by ∼5% per year [4]. Moreover, the adjusted overall incidence of ESRD cases in treatment approximately doubled over this 9-year period, from 12.7 to 23.6 per million population due to diabetes, from 6.3 to 11.5 per million due to hypertension, and from 3.6 to 7.6 per million population due to renovascular disease [4]. The global prevalence of ESRD is 280 cases per million and is subject to regional variations; the prevalence is lower in Europe (585 cases per million) than in North America (1505 cases per million) and Japan (2045 cases per million) [5]. In addition to the information on the incidence and prevalence of ESRD, multiple studies have shown a considerable number of individuals in the general population with a slight-to-moderate decrease in renal function. This population may have an increased risk of ESRD compared with those without renal impairment. Prevalence data from the USA [6] and Europe [7,8] are consistent, with ∼10% of the general population having stage 1–3 CKD. Risk factors for the development of ESRD include diabetes, hypertension, obesity, dyslipidaemia, history of smoking, anaemia and proteinuria/albuminuria. Diabetic nephropathy occurs in up to 40% of diabetic subjects with microalbuminuria and is currently the major cause of ESRD in many regions of the world [9–13]. Worldwide, more than 180 million people are estimated to have diabetes, and this number is projected to more than double by 2030 [14]. Clearly, we need an armamentarium of intervention, as well as prevention measures, to reduce the burden of renal disease now and in the near future. Several such risk management strategies have been tested, targeting risk factors such as hyperglycaemia, hypertension, dyslipidaemia and albuminuria/proteinuria in addition to lifestyle changes [15–20]. Intensive management of all risk factors in diabetes is clearly important in preventing or slowing nephropathy progression [11,21–23]. This armamentarium is needed not only to improve the health of the population concerned, but also to provide lifetime net cost savings with long-term financial benefits offsetting the potential high initial investment costs in preventive strategies. The increasing incidence of ESRD presents a considerable financial burden. Renal dysfunction (decreased eGFR) and ESRD are associated with high morbidity and mortality, and high treatment costs [9,11,24,25]. The primary objective of this paper is to provide an overview of the economic value, from a European perspective, of various pharmacotherapeutic interventions, in slowing renal progression in type 2 diabetic nephropathy.