Strategies for Slowing Progression of Diabetic Nephropathy

  • Anne Marie V. Miles
  • Eli A. Friedman


Over the past 15 years renal disease attributed to diabetes mellitus has emerged as the leading cause of end-stage renal disease (ESRD) in the United States (Figure 1) (1). ESRD is also the leading cause of death in patients with insulin-dependent diabetes mellitus (IDDM) (2); ESRD registries and death certificates, however, may incorrectly presume that all “insulin-treated” diabetics have IDDM, hence deaths in patients with noninsulin dependent diabetes (NIDDM) may also contribute to this statistic. Indeed, most diabetics in ESRD programs have NIDDM, because of the much higher prevalence of NIDDM over IDDM (1). The health care costs per year incurred by diabetics with ESRD in the United States are 20% greater than non-diabetic ESRD patients (3), and the overall expense of medical care for diabetic ESRD patients exceeds $1 billion per year (4). Data from around the world confirm the dominant importance of diabetes to ESRD programs: The European Dialysis and Transplant Association (EDTA) reports that, in 1972, 0.5% of patients treated for ESRD were diabetics, while, in 1985, the figure had risen to 10.5% (5). In Australia and New Zealand, the annual increase in new diabetic ESRD patients has been less marked: 8% in 1985 versus 14% in 1990 (6); while in Japan, in 1990, diabetes accounted for 26.2% of 16,543 new patients begun on maintenance hemodialysis (7).


Diabetic Nephropathy Aldose Reductase Continuous Subcutaneous Insulin Infusion Aldose Reductase Inhibitor Urinary Albumin Excretion Rate 
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Copyright information

© Springer-Verlag London Limited 1992

Authors and Affiliations

  • Anne Marie V. Miles
    • 1
  • Eli A. Friedman
    • 1
  1. 1.Renal Disease Division, Department of MedicineState University of New York, Health Science Center at BrooklynBrooklynUSA

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