The rising tide of endstage renal failure from diabetic nephropathy type II--an epidemiological analysis.

In recent years there has been a substantial increase in the proportion of patients requiring renal replacement therapy who suffer from diabetes mellitus. In the lower Neckar region, a survey has been made comprising all patients admitted for renal replacement therapy from 1.1.1993-30.6.1994. Out of a total of 225 patients admitted, 95 suffered from diabetes (10 type I, 85 type II). The estimated annual incidence of terminal renal failure with diabetes was 52/mio/year. At the same time, 79 patients who suffered from diabetes were admitted to the renal unit in Heidelberg (outpatient clinic and ward) for evaluation of de novo renal failure (approximately 176/mio/year); standard primary chronic renal disease was found in 19/79 of these diabetic patients (25%). The discrepancy between the annual incidence of (i) renal failure and of (ii) terminal renal failure suggests that a high proportion of patients with diabetes (mainly type II) and renal failure, dies prior to reaching terminal renal failure. Potential reasons for the increasing incidence of endstage renal failure from diabetes type II are (i) the increasing prevalence of type II diabetes in Germany in recent decades, (ii) aging of the population in view of the known greater prevalence of type II diabetes in older individuals and (iii) improved survival of patients with type II diabetes secondary to diminished cardiovascular mortality. Particularly because of the latter factor a further increase of endstage renal failure in patients with type II diabetes must be anticipated.