New drugs can help to face a growing challenge

Nephropathy and renal failure remain a major complication of diabetes. New drugs have been developed, and clinical trials have established improved methods of preventing progression of nephropathy to end stage renal failure, yet the proportion of patients with diabetic nephropathy on chronic dialysis programmes is rising. In the United States diabetes has become the most common cause of end stage renal failure in patients starting dialysis.1 In the United Kingdom the figures are progressively increasing. How has this come about?

There are important differences between type 1 and type 2 diabetes. Among white patients in the United Kingdom with type 1 diabetes of 15-30 years' duration, fewer than 20% will have established nephropathy.2 This is broadly comparable to other European centres, although surveys in the United States show higher numbers and data from Sweden show lower numbers.2 The prevalence of nephropathy is higher among patients of Asian or African-Caribbean origin. Although the proportion of patients with type 1 diabetes and nephropathy has reduced over the past 20 years, the increasing incidence of type 1 diabetes over this period will increase the absolute numbers of patients reaching end stage renal failure. In addition, patients with type …