Vol. 10, No 1, 2003 pp. 1 - 15
UC 616.379-008.64+616-008.6
COPING WITH THE COMING PANDEMIC OF RENAL
FAILURE
DUE TO DIABETES MELLITUS
Eli A. Friedman
Department Medicine, Downstate Medical Center, Brooklyn, New York USA
Summary. Europe is locked in the grip of a pandemic of diabe-tes
that now engulfs the new world. In the United States (US), as well as Japan,
and most nations in industrial-ized Europe, diabetes mellitus leads the
causes of end-stage renal disease (ESRD). According to the latest US Renal
Data System (USRDS) Report (2002), of 96,192 patients begun on therapy
for ESRD during 2000, 41,772 (43.4%) had diabetes, an incidence rate of
145 per million population. Overall, survival of diabetic patients with
ESRD has been improving annually over the past decade whether treated by
peritoneal dialysis, hemodialysis, or a kidney transplant. Illustrating
this point is the five year allograft function of 60.1% in diabetic cadaver
kidney transplant recipients versus a five year allograft function of 60.3%
of all recipients reported to the USRDS (1). This encouraging progress
in therapy reflects multiple small advances in understanding of the patho-genesis
of extrarenal micro- and macrovasculopathy in a previously inexorable disease,
coupled with intensified regulation of hypertension and hyperglycemia.
Identifying the per-turbed biochemical reactions underlying the pathogenesis
of diabetic vasculopathy - especially the adverse impact of accumulated
advanced glycosylated end-products (AGEs) - raises the possibility of preempting
end-organ damage without necessarily correcting hyperglycemia.
Key words: Diabetes mellitus, diabetic nephropathy, treatment
