Diabetes Dateline
Fall 2006

Research News

End-Stage Renal Disease Rate Stabilizing, USRDS Finds

Promising Trend Likely Due to Better Care of Patients With Kidney Disease

The rate of end-stage renal disease (ESRD) has stabilized for the first time in the 2 decades such records have been kept, a new Government analysis showed, suggesting that improved treatment may have stopped the steady rise in the number of patients with kidney failure.

The findings, which were released in the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) U.S. Renal Data System (USRDS) 2005 Annual Data Report, show that 338 out of every million Americans had kidney failure in 2003, down slightly from the 340 per million figure in 2002. Still, rates have quadrupled since 1980. The positive news about ESRD comes even as the number of patients at risk for chronic kidney disease continues to grow.

Improved Treatment

Those with diabetes constitute 44 percent of new cases of kidney failure, and the population of people with diabetes is growing. Research published during the 1990s recommended that doctors use new medications to help control diabetes and its consequences. New data suggest that more and more patients are receiving those drugs, according to Paul Eggers, Ph.D., USRDS project officer at the NIDDK.

“The number of people with diabetes is going up but ESRD has stabilized, which suggests that despite the increasing epidemic of diabetes, efficacious treatment is available,” Eggers said. Use of heart drugs, such as angiotension-converting enzyme, or ACE, inhibitors and angiotension receptor blockers, or ARBs, protects the kidneys of patients with diabetes. Increasing the use of those medications as treatments is a major goal of the NIDDK’s National Kidney Disease Education Program.

To better understand the reasons for the falling rates of renal failure among people with diabetes, Eggers said the NIDDK is trying to track people with diabetes through the course of their disease to assess whether keeping close track of blood glucose levels is associated with a drop in the risk of kidney failure.

The promising results were not distributed evenly across the patients surveyed, however. The most marked ESRD decrease was in Caucasian people with diabetes who are younger than 40; their rate of kidney failure dropped 47 percent. Other patient groups, particularly African Americans, have not seen similar gains.

Eggers said the USRDS data, though clearly showing disparity, do not pinpoint the underlying reasons. “The fact of the matter is that minority populations, mostly African Americans, but also Native Americans and even Asian Americans, have much higher rates of ESRD.”

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NIH Publication No. 07–4562
December 2006