SECTION 1:

Prevalence of diabetic kidney disease

The kidneys are important organs which help to maintain fluid balance as well as fulfilling other vital functions, including filtration, secretion and reabsorption. They reabsorb useful materials such as glucose, protein and vitamins during the filtration process, and assist with red blood cell production and maintaining bone health.1 If kidney function is impaired, all of these functions may be affected. Chronic kidney disease (CKD) is common, frequently unrecognised and often exists together with other conditions, such as cardiovascular disease.2 As kidney dysfunction progresses, such co-existing conditions may become more common and increase in severity.2

Kidney disease is one of the most common complications of diabetes: an estimated 40% of people with type 2 diabetes will develop chronic kidney disease (CKD) during their lifetime – most of them within 10 years of diagnosis.3 Over 5% of people with newly diagnosed type 2 diabetes already have CKD.3

Also known as nephropathy, diabetic kidney disease (DKD) is caused when high blood glucose levels damage blood vessels in the kidneys. If detected early it can be treated, but if it progresses unchecked, patients may require renal replacement therapy (dialysis or kidney transplant).4

  • At least 10,350 people in the UK have end stage kidney failure resulting from their diabetes.4
  • More than one in three people who need renal replacement therapy have diabetes.4
  • Almost one in five people with diabetes will need treatment for kidney disease during their lifetime.4
  • People with diabetes are five times more likely than the general population to need dialysis or a kidney transplant.4

CKD is categorised according to estimated glomerular filtration rate (eGFR) and albumin: creatinine ratio (ACR). It is an insidious disease with a clear natural history with a detectable, asymptomatic period during which interventions such as blood pressure control could help prevent or delay progression.5

The estimated prevalence of moderate to severe CKD in people with diabetes in the UK ranges from 18% to 30%.6 The risk of adverse outcomes increases with increasing ACR and decreasing GFR, which in combination multiply the risk of adverse outcomes.2 (Figure 1)

Figure 1. Classification of chronic kidney disease using GFR and ACR categories

GFR and ACR categories and risk of adverse outcomes ACR categories (mg/mmol), description and range
<3
Normal to mildly increased
3-30
Moderately increased
>30
Severely increased
A1 A2 A3
≥90 Normal and high G1 No CKD in the absence of markers of kidney damage    
60-89 Mild reduction related to normal range for a young adult G2    
45-59 Mild-moderate reduction G3a      
30-44 Moderate-severe reduction G3b      
15-29 Severe reduction G4      
<15 Kidney failure G5      

Adapted from NICE CG1822

Reduced eGFR and albuminuria are independent risk factors for cardiovascular events and death in people with diabetes, and kidney disease accounts for 11% of deaths in patients with type 2 diabetes.6

Kidney disease is both a cause and a consequence of hypertension, and is a major independent risk factor for cardiovascular disease (CVD) – excluding hypertension – and CVD is itself an important risk factor for CKD.3 CKD has been shown to increase the risk of angina, myocardial infarction, heart failure, stroke, peripheral vascular disease, arrhythmias and sudden death.3

Job code: UK/DIA-19020d DOP: June 2020

References

  1. National Kidney Foundation. How your kidneys work. https://www.kidney.org/kidneydisease/howkidneyswrk [Accessed June 2020]
  2. NICE CG182. Chronic kidney disease in adults: assessment and management; July 2014 (Updated January 2015). https://www.nice.org.uk/guidance/cg182 [Accessed June 2020]
  3. Couser WG, Remuzzi G, Mendis S, et al. The contribution of chronic kidney disease to the global burden of major non-communicable diseases. Kidney Int 2011;80(12):1258-70
  4. Diabetes UK. Us, diabetes and a lot of facts and stats. https://www.diabetes.org.uk/professionals/position-statements-reports/statistics [Accessed June 2020]
  5. Hippisley-Cox J, Coupland C. Predicting the risk of chronic kidney disease in men and women in England and Wales: prospective derivation and external validation of QKidney Scores. BMC Family Practice 2010;11:49
  6. Diabetes UK. Preventing kidney failure in people with diabetes: Position statement; August 2016. https://www.diabetes.org.uk/professionals/position-statements-reports/specialist-care-for-children-and-adults-and-complications/preventing-kidney-failure-in-people-with-diabetes [Accessed June 2020]