Good news! We always hear that diabetes control isn't great (and it isn't) but new news on the microvascular complications front shows that at least some complications are increasing more slowly now than historically.
Consider. During the 1980s and 1990s, kidney failure rates climbed 5-10% per year. New research just out from NIDDK today, however, shows that since 1999, the rate of kidney failure growth has been less than 1% per year and has finally stabilized at about 338 per million. This marks a four-year trend (four years is what's needed, by the way, to call it a trend, and not chance).
Two sobering notes, however. First, while rates for new cases in whites under 40 were the lowest since the late 1980s, rates for their African American counterparts haven't changed a whit. What is wrong with this picture!? Second, in 2003, over half a million people (537,000) received dialysis or a kidney transplant. This cost a daunting $27 billion, about 2/3 of which was borne by Medicare. NIDDK estimates that 10 million people in the United States have early kidney disease; most don't know they have it or know anything about associated risks.
So it's unbelievable given these costs that anyone worries about drug costs! You could give a lot of drugs to prevent these complications and not even come close to touching the amount that is spent on complications - to say nothing of the pain prompted.
As is so often the case in diabetes, preventive medicine is so close (!) and yet so far away. NIDDK noted that tests to find kidney disease at the earliest, most-treatable stages are not often used - just 10% of the Medicare population had a blood test and only 5% a urine tested for kidney disease. Happily, at least, ACE-inhibitors and ARB use has increased incredibly! For example, the use of these drugs doubled among people over age 60 with CKD, from 16 percent to 32 percent of patients, and nearly half of those who also had diabetes or hypertension or congestive heart failure used them.
As most of you could know or could guess, diabetes stands as the leading cause of kidney failure, accounting for 44% of all new cases. High blood pressure is second at 28%, and of course there is much crossover in these populations.
For more detail, see NIDDK's U.S. Renal Data System (USRDS) at http://www.usrds.org.
U.S. Kidney Failure Rates Stabilize, Ending a 20-Year Climb
Troubling Racial Disparities Persist
BETHESDA, Md., Oct. 11 /PRNewswire/ -- After 20 years of annual increases
from 5 to 10 percent, rates for new cases of kidney failure have stabilized,
according to new research from the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health.
At the same time, dramatic racial disparities persist.
In 2003, the rate for new cases of kidney failure was 338 per million
population, down slightly from 2002 and continuing a four-year trend, finally
allowing researchers to be cautiously optimistic that rate decreases have not
happened by chance. The average annual increase has been less than 1 percent
since 1999, compared to an average 5 percent in the previous decade, according
to research published recently by NIDDK's U.S. Renal Data System (USRDS) at
http://www.usrds.org and being presented next month at the annual scientific
meeting of the American Society of Nephrology.
Diabetes and high blood pressure remain the leading causes of kidney
failure, accounting for 44 percent and 28 percent of all new cases,
respectively. The most striking trends were found in diabetes, where rates
for new cases in whites under age 40 were the lowest since the late 1980's, in
stark contrast to rates for their African American counterparts, which have
not budged.
"It's gratifying to see progress, however small, and to know that NIDDK
activities undoubtedly have had a hand in that success," said Paul W. Eggers
Ph.D., NIDDK's co-director for the USRDS. "But persistent disparities are
sobering."
Credit for recent gains likely goes to clinical strategies proven in the
1990s to significantly delay or prevent kidney failure: angiotensin-
converting enzyme inhibitors (ACE-inhibitors) and angiotensin receptor
blockers (ARBs), which lower protein in the urine and are thought to directly
prevent injury to the kidneys' blood vessels; and careful control of diabetes
and blood pressure. The launch of private and government programs to improve
care and increase awareness coincided with these developments, including
NIDDK's National Kidney Disease Education Program (NKDEP).
NKDEP encourages early diagnosis and management by increasing awareness
about:
* the connection between diabetes, high blood pressure and kidney
disease
* strategies proven to prevent or delay kidney failure
* estimating kidney function (eGFR) to find kidney disease earlier
* efforts to standardize testing for kidney disease and encourage more
labs to automatically report eGFR, and
* time-saving tools for health professionals at
http://www.nkdep.nih.gov, including eGFR calculators that eliminate
most of the work to estimate kidney function; and a letter template,
which automatically calculates patient-specific eGFR, generates a list
of next steps based on kidney disease stage and is designed to improve
communication between kidney specialists and primary care physicians.
Despite incremental successes in preventing kidney failure and in
improving health and survival of people who have it already, the increasing
and aging U.S. population means that more people than ever before are getting
and living with the disease. In 2003, nearly 537,000 people received dialysis
or a kidney transplant. The cost to Medicare was $18.1 billion, with another
$9.2 billion borne by private insurers and patients. Another 10 million
people in the United States have earlier kidney disease; most don't know they
have it, let alone that the disease increases the risk for premature death,
heart attacks, strokes, and other problems.
The research also found both encouraging and discouraging news about the
quality of care for people with chronic kidney disease (CKD), an earlier stage
that precedes kidney failure. Tests to find kidney disease at the earliest,
most-treatable stages are not widely used. Only 10 percent of the general
Medicare population had a blood test and only 5 percent had urine tested for
kidney disease. But, while ACE-inhibitors and ARBs are still underutilized,
there has been a dramatic increase in their use. In the past decade, the use
of these drugs doubled among people over age 60 with CKD, from 16 percent to
32 percent of patients, and nearly half of those who also had diabetes or
hypertension or congestive heart failure used them.
"We could prevent or delay a lot more kidney failure, simply by using the
box of tools that are already in the trunk," said Josephine P. Briggs, M.D., a
kidney specialist and director of NIDDK's Division of Kidney, Urologic, and
Hematologic Diseases.
USRDS research depends on collaborations with other agencies of the U.S.
Department of Health and Human Services (HHS), especially the Centers for
Medicare and Medicaid Services, but also the United Network for Organ Sharing
and the Centers for Disease Control and Prevention. Patient registries for
other countries also contribute data for analyses.
NIDDK, part of the National Institutes of Health (NIH), conducts and
supports research and education programs on kidney disease and diabetes, among
others. Learn more about NIDDK programs and diseases at
http://www.niddk.nih.gov.
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