St Vincent Declaration, 1994: Guidelines for the Prevention of Diabetic Renal Failure

Abstract

Diabetic nephropathy is a major cause of premature death in diabetic patients, largely from uraemia and cardiovascular disease. Diabetic nephropathy develops in about 30% of people with insulin-dependent diabetes mellitus. The cumulative risk of nephropathy in people with non-insulin-dependent diabetes varies considerably with ethnic origin. It ranges from 25 % in individuals of European origin to around 50% in other ethnic groups such as the Afro-Caribbean, Asian Indians, and the Japanese. In the UK geographic areas at high density of these ethnic groups are likely to experience a higher incidence of renal disease. Asian Indians develop non-insulin-dependent diabetes more frequently and at a younger age than Europeans and Afro-Caribbean have a significantly higher frequency of arterial hypertension. All these factors are believed to contribute to their higher risk of kidney failure. Overall non-insulin-dependent diabetes is significantly more common than insulin-dependent diabetes and the number of non-insulin-dependent diabetic patients being accepted into renal replacement therapy (RRT) programmes is now equal, if not greater, than that of insulin-dependent diabetics. In Europe diabetes is the only increasing cause of end-stage renal failure and diabetic patients represent around 13 % of all patients receiving RRT. This percentage rises to approximately 30% in the United States of America. The cost of renal replacement therapy for end-stage diabetic renal failure in the United States was around $2 thousand million in 1991.