The incidence of treatment for end-stage renal disease (ESRD) in people with diabetes continues to decline, a trend that could be related to improved treatment and care and a decrease in the prevalence of ESRD risk factors, according to a recently published study.

The number of individuals who began diabetes-related ESRD treatment (dialysis or kidney transplantation) rose from 17,727 in 1990 to 48,215 in 2006. From 1990 to 1996, the age-adjusted incidence of treatment for diabetes-related ESRD rose from 299.0 to 343.2 per 100,000 diabetic population. From 1996 to 2006, however, the incidence decreased by 3.9% per year from 343.2 to 197.7 per 100,000 diabetic population, the investigators reported in Diabetes Care (2010;33:73-77).

The researchers, Nilka Ríos Burrows, MPH, and colleagues at the Centers for Disease Control and Prevention in Atlanta, used the U.S. Renal Data System to obtain the number of individuals having diabetes listed as a primary diagnosis and who initiated ESRD treatment between 1990 and 2006. They calculated incidence using the estimated U.S. population with diabetes from the National Health Interview Survey.

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Among people with diabetes younger than 45 years, the incidence decreased by 4.3% per year from 1990 to 2006. Among individuals aged 45-64 years, the incidence rose from 340.6 to 451.8 per 100,000 diabetic population from 1990 to 1996, and then decreased by 3.9% per year to 273.8 per 100,000 diabetic population in 2006. Among those aged 65-74 years, the incidence increased from 263.8 to 448.2 per 100,000 diabetic population from 1990 to 1998, and then decreased by 3.4% per year to 368.6 per 100,000 diabetic population in 2006. Among individuals aged 75 and older, the incidence increased from 172.5 to 380.0 per 100,000 diabetic population from 1990 to 1999, and, from 1999 to 2006, declined by 2.1% per year to 328.5 per 100,000 diabetic population.

Reasons for the decreasing trends might include early detection and management of kidney disease, improved treatment and care, and better control of ESRD risk factors, such as diabetes and hypertension, the authors stated. Another possible explanation for the declines in incidence, they noted, is that a large and sustained increase of new diabetes cases that has occurred since the 1990s may have led to a large number of individuals who have not had diabetes long enough to develop ESRD.