Chronic kidney disease in type 2 diabetes: trends in prevalence, clinical phenotypes and outcomes

Type 2 diabetes (T2D) is a leading cause of chronic kidney disease (CKD). This review analyzes the results of studies assessing the prevalence, clinical phenotypes, and outcomes of CKD in T2D. Over the past 20–30 years, there has been a global trend toward an increase in the number of patients with T2D and CKD. At the same time, the prevalence of CKD among patients with T2D appears to remain stable and averages 25–30%. Studies from different countries demonstrate both upward and downward trends in the prevalence of CKD among patients with T2D. This can be explained by differences in study design, CKD screening quality, and real differences in the prevalence of CKD in different populations. In patients with T2D, CKD is heterogeneous in morphological and clinical characteristics, course, and outcomes. An obvious current trend in the epidemiology of CKD in patients with T2D is an increasing prevalence of renal function decline in the absence of albuminuria. Female sex, older age, optimal glycemic and hypertension control, use of renin-angiotensin system blockers, and the absence of diabetic retinopathy are associated with non-albuminuric CKD in T2D. Patients with T2D with the albuminuric phenotype of CKD appear to have a higher risk of developing end-stage renal disease and major adverse cardiovascular events compared with patients with T2D and non-albuminuric CKD. The reported incidence of end-stage renal disease in patients with T2D varies widely, from 0.41 to 6.9 cases per 1000 patient-years. The diversity of data may be explained by differences in baseline patient characteristics and different durations of follow-up. The heterogeneity of the design of studies conducted to date, the small number of prospective studies on large patient samples make it difficult to objectively assess the dynamics of CKD prevalence and incidence in patients with T2D. Further real-world evidence studies are urgently needed to assess the epidemiology of CKD in patients with T2D.