article: 1 from 1  
Facta universitatis - series: Medicine and Biology
2003, vol. 10, iss. 1, pp. 1-15
article language: English
unclassified
Coping with the coming pandemic of renal failure due to diabetes mellitus
Department Medicine, Downstate Medical Center, Brooklyn, New York USA

Abstract

Europe is locked in the grip of a pandemic of diabetes that now engulfs the new world. In the United States (US), as well as Japan, and most nations in industrialized Europe, diabetes mellitus leads the causes of end-stage renal disease (ESRD). According to the latest US Renal Data System (USRDS) Report (2002), of 96,192 patients begun on therapy for ESRD during 2000, 41,772 (43.4%) had diabetes, an incidence rate of 145 per million population. Overall, survival of diabetic patients with ESRD has been improving annually over the past decade whether treated by peritoneal dialysis, hemodialysis or a kidney transplant. Illustrating this point is the five year allograft function of 60.1% in diabetic cadaver kidney transplant recipients versus a five year allograft function of 60.3% of all recipients reported to the USRDS (1). This encouraging progress in therapy reflects multiple small advances in understanding of the pathogenesis of extrarenal micro- and macrovasculopathy in a previously inexorable disease, coupled with intensified regulation of hypertension and hyperglycemia. Identifying the perturbed biochemical reactions underlying the pathogenesis of diabetic vasculopathy − especially the adverse impact of accumulated advanced glycosylated end-products (AGEs) − raises the possibility of preempting end-organ damage without necessarily correcting hyperglycemia.

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