Diabetes and chronic kidney disease: Lessons from renal epidemiology

In industrialized countries, renal epidemiology is faced with the growing epidemic of diabetes as cause of renal involvement or as an associated condition. In France, recent studies estimate that 400 000+ diabetics have a glomerular filtration rate lower than 60 mL/min/1.73 m(2), and that 7000+ are prevalent in dialysis. The vast majority has type 2 diabetes. In type 1 diabetes, renal prognosis improved over the last decade due to available aggressive glycemic control and treatment with renin-angiotensin system inhibitors. Diabetes has a negative impact on survival in end-stage renal disease, particularly for type 1 diabetes patients and for women with diabetes. In type 2 diabetes, improvement in early access to renal transplant could lead to improvement in outcomes, whereas they are usually contra-indicated for transplant because rapid decline in cardiovascular status on dialysis. All these epidemiological data help us to implement preventing measures and further researches in order to improve diabetes patient prognosis. (C) 2010 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved.