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Nephrology 19 (2014) 450–458
Review Article
Diabetic kidney disease in Australia: Current burden and future projections SARAH WHITE1 and STEVE CHADBAN1,2 1 Charles Perkins Centre and Sydney Medical School, The University of Sydney, and 2Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
KEY WORDS: chronic kidney disease, diabetic nephropathy, end-stage kidney disease, epidemiology. Correspondence: Dr Sarah White, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia. Email: [email protected] Accepted for publication 22 May 2014. Accepted manuscript online 28 May 2014. doi:10.1111/nep.12281
SUMMARY AT A GLANCE This important review eloquently describes the current and future projected burden of diabetic kidney disease. There is positive news in that early detection of diabetic kidney disease and optimal management are proving successful strategies to slow the rate of disease progression.
ABSTRACT: Diabetes mellitus is now the most common cause of new cases of end-stage kidney disease treated with kidney replacement therapy in Australia. In addition to the approximately 5000 Australians receiving maintenance dialysis or living with a kidney transplant as a consequence of diabetes, many die from untreated end-stage kidney disease due to diabetes (DMESKD) each year. For every Australian receiving renal replacement therapy due to diabetes, at least 50 others have earlier stages of diabetic kidney disease (DKD). Based on projected increases in type 2 diabetes prevalence, the size of this underlying population with DKD will potentially exceed half a million by 2025. In addition to the risk of developing DM-ESKD, this population is at increased risk of premature cardiovascular morbidity and all-cause mortality. Higher rates of hospitalization, use of specialist services and prescription drugs mean that those with DKD also incur significantly greater health care costs compared with those with diabetes or chronic kidney disease alone. However, in contrast to the increasing prevalence of diabetes and early stages of DKD, recent trends in the incidence of DM-ESKD suggest that better management in the earlier stages of DKD has been successful in slowing rates of disease progression. Simultaneous improvements in use of renin–angiotensin inhibitors and improved glycaemic and blood pressure control are likely to be largely responsible for this trend. Primary prevention, maximizing early detection of DKD and optimal management of diabetes and kidney disease hold great potential to attenuate the future health burden attributable to DKD in Australia.
Diabetes-related kidney disease (DKD) may be defined as the presence of persistent albuminuria, proteinuria and/or estimated glomerular filtration rates (eGFR) 2.5 mg/mmol in men, >3.5 mg/mmol in women) OR presence of proteinuria (protein to creatinine ratio >200 mg/g). ‡Albuminuria defined as albumin to creatinine ratio >2.5 mg/mmol in men, >3.5 mg/mmol in women. §Estimate unreliable due to small sample size in this age group. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.
EPIDEMIOLOGY OF DIABETES-RELATED KIDNEY DISEASE IN AUSTRALIAN ADULTS The baseline AusDiab Study conducted in 1999/2000 found that among Australian adults (25 years and older) with diabetes, 27% had evidence of DKD (Table 1). These data suggest that approximately a quarter of a million Australians have DKD, and because of this are at high risk of progression to DM-ESKD, cardiovascular events and premature death. By comparison, the prevalence of DKD in the United States diabetic population was 40%, according to the results of the 2005–2010 NHANES survey.5 Based on AusDiab data, the vast majority (94%) of the adult DKD population exhibited albuminuria, either alone or in combination with a low estimated eGFR. Only an estimated 6% of diabetic nephropathy was indicated by a low eGFR alone (for eGFR calculated according to the CKD-EPI equation). By comparison, of the chronic kidney disease (CKD) population without diabetes, an estimated 24% have an eGFR
Nephrology 19 (2014) 450–458
Review Article
Diabetic kidney disease in Australia: Current burden and future projections SARAH WHITE1 and STEVE CHADBAN1,2 1 Charles Perkins Centre and Sydney Medical School, The University of Sydney, and 2Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
KEY WORDS: chronic kidney disease, diabetic nephropathy, end-stage kidney disease, epidemiology. Correspondence: Dr Sarah White, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia. Email: [email protected] Accepted for publication 22 May 2014. Accepted manuscript online 28 May 2014. doi:10.1111/nep.12281
SUMMARY AT A GLANCE This important review eloquently describes the current and future projected burden of diabetic kidney disease. There is positive news in that early detection of diabetic kidney disease and optimal management are proving successful strategies to slow the rate of disease progression.
ABSTRACT: Diabetes mellitus is now the most common cause of new cases of end-stage kidney disease treated with kidney replacement therapy in Australia. In addition to the approximately 5000 Australians receiving maintenance dialysis or living with a kidney transplant as a consequence of diabetes, many die from untreated end-stage kidney disease due to diabetes (DMESKD) each year. For every Australian receiving renal replacement therapy due to diabetes, at least 50 others have earlier stages of diabetic kidney disease (DKD). Based on projected increases in type 2 diabetes prevalence, the size of this underlying population with DKD will potentially exceed half a million by 2025. In addition to the risk of developing DM-ESKD, this population is at increased risk of premature cardiovascular morbidity and all-cause mortality. Higher rates of hospitalization, use of specialist services and prescription drugs mean that those with DKD also incur significantly greater health care costs compared with those with diabetes or chronic kidney disease alone. However, in contrast to the increasing prevalence of diabetes and early stages of DKD, recent trends in the incidence of DM-ESKD suggest that better management in the earlier stages of DKD has been successful in slowing rates of disease progression. Simultaneous improvements in use of renin–angiotensin inhibitors and improved glycaemic and blood pressure control are likely to be largely responsible for this trend. Primary prevention, maximizing early detection of DKD and optimal management of diabetes and kidney disease hold great potential to attenuate the future health burden attributable to DKD in Australia.
Diabetes-related kidney disease (DKD) may be defined as the presence of persistent albuminuria, proteinuria and/or estimated glomerular filtration rates (eGFR) 2.5 mg/mmol in men, >3.5 mg/mmol in women) OR presence of proteinuria (protein to creatinine ratio >200 mg/g). ‡Albuminuria defined as albumin to creatinine ratio >2.5 mg/mmol in men, >3.5 mg/mmol in women. §Estimate unreliable due to small sample size in this age group. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.
EPIDEMIOLOGY OF DIABETES-RELATED KIDNEY DISEASE IN AUSTRALIAN ADULTS The baseline AusDiab Study conducted in 1999/2000 found that among Australian adults (25 years and older) with diabetes, 27% had evidence of DKD (Table 1). These data suggest that approximately a quarter of a million Australians have DKD, and because of this are at high risk of progression to DM-ESKD, cardiovascular events and premature death. By comparison, the prevalence of DKD in the United States diabetic population was 40%, according to the results of the 2005–2010 NHANES survey.5 Based on AusDiab data, the vast majority (94%) of the adult DKD population exhibited albuminuria, either alone or in combination with a low estimated eGFR. Only an estimated 6% of diabetic nephropathy was indicated by a low eGFR alone (for eGFR calculated according to the CKD-EPI equation). By comparison, of the chronic kidney disease (CKD) population without diabetes, an estimated 24% have an eGFR
