This article appears in the following NDT Plus issue: Dialysis Initiatives May 2007, Berlin, Germany [View the issue table of contents]
Prevalence of nephropathy in the German diabetes population—Is early referral to nephrological care a realistic demand today?
Department of Internal Medicine-Nephrology, Vivantes Humboldt Hospital, Berlin, Germany
Correspondence: Wolfgang Pommer, Department of Internal Medicine-Nephrology, Vivantes Humboldt Hospital, Am Nordgraben 2, D-13509, Berlin, Germany. Tel: +49-30-13012-2170; Fax: +49-30-13012-2186; E-mail: wolfgang.pommer{at}vivantes.de
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Abstract |
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In Germany, diabetes mellitus in the general population has increased to 
8 million people. The implication of this trend for future nephrological care is not well known, as data on this issue are rather limited. Results from different population-based studies suggest that microalbuminuria in diabetic patients is present in 20–30% of the cases. Findings from the diabetes disease management programme in the North-Rhine area revealed the prevalence of chronic kidney disease (CKD) stage II in half of the participants (CKD stage III was present in 20%). Only a small proportion of this cohort (1–2%) will reach end-stage renal failure, probably due to the excess mortality risks attributed to advanced kidney disease. Results from the QUASI-Niere registry, which reports on renal replacement therapy in Germany, indicate almost constant incidence and prevalence rates of diabetes in the last 5 years (30.6–34.2% and 23.6–27.1%, respectively). The high percentages of early stages of CKD in the diabetes population indicate a potentially high burden of future nephrological care, especially if patients are referred to nephrologists at an early stage. In reality, in nephrological care, bearing this burden is impossible without expanding the resources for this patient group.
Key Words: chronic kidney disease • diabetes mellitus • health costs • nephrological care • referral politics
Received for publication March 6, 2008. Accepted for publication June 19, 2008.