Diabetes Mellitus as a Leading Cause of End-Stage Renal Disease

End-stage renal disease (ESRD) can be considered a health epidemic involving considerable human and financial resources. The number of patients with ESRD is increasing in the world due to aging populations, longer life expectancy, increasing access to renal replacement therapies (RRT), and higher incidence of diabetes mellitus (DM) and hypertension. Nowadays, dialysis is the dominating therapy to prevent death from uremia, in large part because donor kidneys are in short supply, and thus, the survival of these patients is still a major concern. According to the United States Renal Data System (USRDS), in 2008, the adjusted rate of prevalent ESRD cases rose 1.9%, to 1.699 per million population (pmp), with 547.982 patients under treatment.

The prevalent dialysis population increased 3.6%, reaching 382.343 patients and has grown 34.7% since 2000. Among these amazing numbers, DM is present as the leading cause of ESRD in the USA and most other countries. After a dramatic increase in the incidence rate of ESRD due to diabetes, peaking in 2006 at 160 pmp, this rate fell 3.2% and 1.5% in the following two years, reaching 153 pmp in 2008, but still corresponding to 43% of all incident patients.

Although their survival is still much worse than that of nondiabetic counterparts, mainly because of the preexisting severely compromised cardiovascular conditions, between 1994–1998 and 1999–2003, the 5-year diabetic patients survival improved 15.3% in hemodialysis (HD) and 27.1% in peritoneal dialysis (PD), reaching 29% and 27%, respectively. In Europe, diabetes as the cause of ESRD averaged 124 pmp. In the cohort 1999–2003, the unadjusted 1-, 2- and 5-year survival of patients on RRT was 80.8% (95% CI: 80.6–81.0), 69.1% (95% CI: 68.9–69.3), and 46.1% (95% CI: 45.9–46.3), respectively. Survival of incident diabetic patients either in HD and PD was the lowest and around 30% by 5 years.

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Partial Nephrectomy for Kidney Cancer Lowers ESRD Risk

End-stage renal disease is a condition in which the kidneys no longer function normally. The most common causes of ESRD in the U.S. are diabetes and high blood pressure. These conditions can affect your kidneys. Some problems you are born with, some reactions to medicines, and some injuries can also cause ESRD. They both need to fail for end-stage renal disease to develop.

Patients with renal cell carcinoma (RCC) are at lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy if they undergo partial rather than radical nephrectomy, a new study suggests.

The population-based, retrospective cohort study of 11,937 RCC patients who underwent radical nephrectomy (RN) or partial nephrectomy (PN) during 1995–2010. Researchers divided subjects into an early cohort (those who had surgery from 1995–2002) and a modern cohort (those who had surgery from 2003–2010).

In the full cohort, the study revealed no significant association between type of surgery and ESRD rate, but PN was associated with a significant 52% decreased risk of chronic kidney disease (CKD).

In the modern cohort, PN recipients had a significant 56% decreased risk of ESRD requiring renal replacement therapy (RRT) compared with patients who underwent RN, after a median follow-up of 41 months, researchers led by Stanley A. Yap, MD, of the University of California Davis in Sacramento, reported online ahead of print in BJU International. In a propensity score analysis, which the investigators used to decrease bias and to control for differences between treatment groups, PN was associated with a significant 53% decreased risk of ESRD.

In the modern cohort, the RN and PN patients had a median time of progression to ESRD of 5 months and 16 months, respectively.

“Although it is well-known that RN is associated with more CKD than PN, we provide the first direct evidence that PN is associated with ESRD requiring renal replacement therapy than RN in a modern cohort of patients with RCC,” the authors concluded.

They also stated, “The distinction of a modern cohort is important, as it consists of patients that encompass a more accurate representation of current practice,” the investigators wrote. “During earlier years of the present cohort, PN had yet to gain widespread use and acceptance.”

Of the 11,937 patients in the full cohort, 9,830 (82%) and 2,107 (18%) underwent RN or PN, respectively. Overall, during the postoperative period, ESRD developed in 292 patients (2.5%). The group included 47 patients in the PN group (2.2%) compared with 245 patients in the RN group (2.5%). The mean time to progression to ESRD was 19 months and 38 months for patients in the RN and PN groups, respectively.

The early cohort included 4,297 RN patients and 360 PN patients, which had unadjusted rates of ESRD of 3.7% and 8.6%, respectively. The modern cohort included 5,484 (76%) and 1,746 (24%) patients who underwent RN and PN, respectively, and their unadjusted rates of ESRD were 1.6% and 0.9, respectively. If you have any questiosn you can send email to kidneyhospitalabroad@hotmail.com.