The changing landscape of diabetic kidney disease: New reflections on phenotype, classification, and disease progression to influence future investigative studies and therapeutic trials

摘要

Diabetic kidney disease (DKD) occurs in approximately 1/3 of adults with diabetes. Growth of CKD has increased in parallel with rising prevalence rates of diabetes. This growth has occurred irrespective of the increased use of glucose-lowering medications and anti-hypertensive therapy, including the use of renin-angiotensin-aldosterone system (RAAS) inhibitors. The adjusted increase in DKD prevalence was 34% from 1988 to 2004 through 2005 to 2008 despite reciprocal decreases in mean hemoglobin A1c, systolic and diastolic blood pressures, and low-density lipoprotein cholesterol levels over the same time period. The incidence rate of ESRD from diabetes, although high, appears to have declined slightly as of 2011, although temporal trends in ESRD incidence differ by age and race/ethnicity.