Evolution Worldwide of the Treatment of Patients with Advanced Diabetic Nephropathy by Renal Replacement Therapy
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 , largely due to an excess of cardiovascular disease . 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 . 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  to over 10% in the mid-1980’s . 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 , compared with 3.6 per million in Europe in 1985 .
KeywordsDiabetic Patient Diabetic Nephropathy Peritoneal Dialysis Renal Replacement Therapy Nephrol Dial Transplant
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- 2.Brunner P and Selwood NH. Profile of patients on RRT in Europe and death rates due to major causes of death groups. Kidney Int 1992; 42: Suppl. 38: S4–S15.Google Scholar
- 4.Brunner FP, Giesecke B, Gurland HJ, et al. Combined report on regular dialysis and transplantation in Europe, V, 1974. Proc Euro Dial Transp Assoc 1976; 12: 2–64.Google Scholar
- 6.Held PJ, Port FK, Blagg CR, Agodoa LYC. United States Renal Data System 1990 annual report. Am J Kidney Dis 1990; Suppl. 2: 1–106.Google Scholar
- 9.Jarrett RJ. »The epidemiology of diabetes mellitus.« In Textbook of Diabetes, vol 1. Pickup J, Williams G, eds. Oxford: Blackwell Scientific Publications, 1991; pp 47–56.Google Scholar
- 10.United States Renal Data System 1991 Annual Data Report. Incidence and causes of treated ESRD. Am J Kidney Dis 1991; 17: Suppl. 2: 30–37.Google Scholar
- 11.The 1993 USRDS Annual Data Report. Incidence and causes of treated ESRD. Am J Kidney Dis 1993; 22: Suppl. 2: 38–45.Google Scholar
- 12.US Renal Data System, USRDS 1992 Annual Data Report. The National Institutes of Health, Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; August 1992.Google Scholar
- 13.Canadian Organ Replacement Register, 1991 Annual Report. Don Mills, Ontario: Hospital Medical Records Institute; April 1993.Google Scholar
- 16.Stephen SGW, Gillaspry JA, Clyne D, Mejia A, Pollok VE. Racial differences in the incidence of end stage renal disease in type I and type II diabetes mellitus. Am J Kidney Dis 1990; 15: 562–567.Google Scholar
- 20.Geerlings W, Tufveson G, Brunner FP, et al. Combined report on regular dialysis and transplantation in Europe, XXI, 1990. Nephrol Dial Transplant 1991; 6: Suppl. 4: 5–28.Google Scholar