Worldwide epidemiology of diabetes-related end-stage renal disease, 2000–2015

Objective The annual risk among diabetic patients to reach end-stage renal disease (ESRD) is largely unknown worldwide. This study aimed to compare the incidence of diabetes-related ESRD by creating a global atlas during 2000–2015. Research Design and Methods The annual incidence of ESRD among diabetic patients was calculated as the quotient of the number of incident ESRD patients with diabetes divided by the total number of patients with diabetes after subtracting the number with existing ESRD. The estimated ESRD prevalence and annual incidence were validated using the data provided by Fresenius Medical Care, Germany, and previously reported data, respectively. Results Data were obtained from 142 countries, covering 97·3% of the world population. The global percentage of the prevalent ESRD patients with DM increased from 19·0% in 2000 to 29·7% in 2015 worldwide, while the percentage of incident ESRD patients due to DM increased from 22·1% to 31·3%. The global annual incidence of ESRD among DM patients increased from 375·8 to 1016·0/million with DM during 2000–2015. The highest average rates were observed in the Western Pacific Region. Comparatively, the rates of incident ESRD among European DM patients ranged from half (309·2 vs 544·6) to a third (419·4 vs 1245·2) of the rates of the Western Pacific population during 2000–2015. Conclusions Great and nonrandom geographic variation in the annual rates among diabetic patients to reach ESRD suggests that distinct healthcare, environmental, and/or genetic factors contribute to the progression of diabetic kidney disease. Measures to prevent and treat DM-related ESRD require better patient susceptibility stratification.