Patients with Diabetic Nephropathy in Established Renal Failure: Demographics, Survival and Biochemical Variables (Chapter 16)

Diabetic nephropathy is now the most common renal disease leading to renal replacement therapy in developed countries1,2,3,4. Within the UK, the number of DN patients accepted for RRT rose steadily in the 1990s5 especially in the African–Caribbean and South Asian populations3,4,5,6. This may be related to the increased prevalence of Type 2 diabetes in the general population, the ageing population and the liberalisation of attitudes to acceptance for RRT5,7. The overall rise has slowed in the last 4 years8 . DN patients starting RRT are likely to have more co-morbidity than other patients, in particular cardiovascular disease, and consequently worse survival on RRT9,10,11. In recent years there has been some reduction in the high mortality of such patients, so the prevalence of diabetic nephropathy patients on RRT (currently lower than the percentage of incident patients, see Chapter 3) might increase12,13. The National Service Frameworks for Diabetes14 and for Renal Services15 have highlighted the importance of the primary prevention of DN in diabetic patients by early detection and aggressive management of hypertension, glucose control and cardiovascular risk factors and of the timely referral (recommendation >1 yr before RRT) of those with progressive renal disease in order to plan for RRT. 251 There is a key policy drive to reduce health inequalities in England16. In the UK there is evidence that diabetic patients in more socially deprived areas have higher all cause mortality even after adjustment for smoking and blood pressure9 , and lower rates of attendance at GP and hospital clinics17. The UK Renal Registry 2003 Report highlighted the possible role of social deprivation in the context of DN. This chapter examines the characteristics of patients developing established renal failure from DN, their access to modalities of treatment and their survival on RRT relative to other incident patients. It also includes data on quality of care (HbA1c, cholesterol and blood pressure). These analyses were undertaken before individual patient data from the Scottish Registry became available and therefore only includes England and Wales.