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Diabetes partly to blame for rise in kidney failure

Last Updated: 2003-05-29 10:00:28 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Over the past two decades, the number of Americans with the most advanced form of kidney disease -- end-stage renal disease -- has increased substantially and steadily, and researchers say they aren't exactly sure why.

In end-stage renal disease, both kidneys lose their ability to filter waste products from the blood and excrete them in the urine. People with end-stage renal disease need kidney dialysis or a kidney transplant to stay alive.

The increase in the disease has been blamed on the rapid rise of diabetes and the fact that more people are surviving heart attacks and stroke. These groups of people are at very high risk of developing kidney disease that requires treatment.

But results of a new study place only partial blame on these factors.

In the study, researchers used data collected in 1978 and 1991 in a national survey to estimate end-stage kidney disease cases resulting from diabetes and improved heart attack and stroke survival.

Compared to 1978, in 1991 there were roughly 4.3 million more people with diabetes, 1.2 million more with a history of heart attack or stroke and 36,881 more people requiring treatment for end-stage kidney disease.

According to the team, nearly 28 percent of the additional cases of treated end-stage kidney disease in 1991 resulted from diabetes, and about five percent resulted from increased heart attack and stroke survival.

The prevalence of diabetes increased by 59 percent between 1978 and 1991, according to the report. Overall, 50 percent of cases of end-stage kidney disease that required treatment in 1991 involved diabetics.

In a telephone interview, lead author Dr. Paul Muntner from Tulane University in New Orleans, said it is not very surprising that the rapid increase in diabetes has had an impact on kidney failure.

What is surprising, he said, is the "minimal impact" that better heart attack and stroke survival has had.

"These people are not the ones that are causing the increase in kidney failure," Muntner said.

In the June issue of the Journal of the American Society of Nephrology, Muntner and colleagues report that the reasons for a majority of the increase in treated kidney failure incidence "remain unresolved."

Nonetheless, Muntner told Reuters Health that people should not think that diabetes, heart attack and stroke are not important factors in kidney failure.

"Our study reminds us that people with diabetes and those who've had heart attacks and strokes are at very high risk for kidney failure and we should work hard to prevent diabetes because diabetes is causing trends in other diseases," he said.

Greater access to or more liberal use of dialysis might also underlie the rise in treated kidney failure, as might the more widespread use of pain relievers that can be toxic to the kidneys, according to Muntner's team.

Copyright 2002 Reuters.