Evolution Worldwide of the Treatment of Patients with Advanced Diabetic Nephropathy by Renal Replacement Therapy

Abstract

Of all the complications of diabetes mellitus, diabetic nephropathy is one of the most feared. The need for renal replacement therapy (RRT) itself imposes many burdens. Moreover, despite the now widespread availability of such treatment, the survival of patients with end stage renal disease remains disturbingly low [1], largely due to an excess of cardiovascular disease [2]. These problems have become increasingly clear over the past decade, as greater numbers of diabetic patients have entered dialysis and transplant programmes. In the past, access to RRT of patients with end stage diabetic nephropathy was restricted in Europe, particularly in those countries where limitations in resources for provision of RRT historically existed [3]. The dramatic and sustained growth in the availability and provision of this life saving treatment has led to worldwide increases in acceptance of diabetic patients for RRT; for example, it has grown from less than 2% of treated patients in Europe in 1974 [4] to over 10% in the mid-1980’s [5]. However, the proportion of RRT patients with diabetic nephropathy is much higher in other countries, notably the United States, where according to the United Stages Renal Data System (USRDS) approximately one third of all RRT patients have diabetic nephropathy, and the annual incidence of end stage renal failure in diabetic patients alone is over 40 per million population [6], compared with 3.6 per million in Europe in 1985 [5].

Deceased October 14th, 1995