Purpose of review: To summarize recent trends in the prevalence of nephropathy due to diabetes and to assess the causes of these changes. Such analysis may influence our strategy to reduce the increasing numbers of cases.
Recent findings: Registry data show a progressive increase in the number of cases of nephropathy due to type 2 diabetes such that diabetes is now the leading cause of end-stage renal failure. Despite the increasing incidence of type 1 diabetes, European data indicate the numbers of type 1 patients going on to dialysis are stable. The increase in the prevalence of type 2 diabetes, which in itself is related to increasing levels of obesity, is a major factor but the increase in end-stage renal failure is disproportionately greater. Other factors are therefore important such as earlier development of diabetes and better prevention of coronary events. Similar changes are occurring worldwide. Clinical predictors and genetic markers are being studied.
Summary: More active management of proteinuric type 2 diabetic patients is required to achieve the demanding targets recommended on the basis of clinical trial data. However, the figures suggest that only widespread application of public health measures aimed at the epidemic of type 2 diabetes itself will prevent further rapid escalation of the numbers of type 2 patients reaching end-stage renal failure.