IDF ATLAS

REPORTS
2023

Diabetes and Kidney Disease

 Acknowledgements

Diabetes and Kidney Disease

Authors:

Meda E. Pavkov, Yoshihisa Miyamoto

Chronic Kidney Disease Initiative, Division of Diabetes

Translation, at the Centers for Disease Control and
Prevention, Atlanta, GA

Editorial Team:

Dianna J Magliano (Atlas Co-chair), Edward J Boyko

(Atlas Co-chair), Irini Genitsaridi, Lorenzo Piemonte,
Phil Riley, Paraskevi Salpea

Corporate sponsors

2 | Diabetes and kidney disease – 2023 | www.diabetesatlas.org

 Table of Contents

04
Diabetes and chronic kidney disease

05
Diabetes and kidney failure

06
Reducing the burden of CKD in diabetes

07
References

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 Diabetes and chronic kidney disease

Key messages

■ Diabetes is one of the leading causes of chronic

kidney disease (CKD) and end-stage kidney
disease (ESKD)

■ CKD due to type 2 diabetes increased worldwide by

about 74% between 1990 and 2017. However, there has
been a decline in CKD incidence among people with
type 1 diabetes

■ Most data on the epidemiology of CKD come from

high-income countries, although countries with
lower socioeconomic status experience the largest
increase in diabetes prevalence

■ People living with diabetes-related kidney disease

are at higher risk of cardiovascular disease (CVD),
progression to kidney failure, and death

Diabetes is one of the leading causes of chronic kidney The prevalence of diabetes-related CKD increases
disease (CKD), with approximately 30 to 40% of people with age and varies widely between countries,
living with diabetes developing CKD. Type 2 diabetes depending on the setting, the definition of CKD,
is by far the largest contributor to the burden of CKD and the local healthcare infrastructure.3 The odds of
associated with diabetes. Kidney damage can result CKD are between 1.3 and 4.6 higher in populations with
directly from hyperglycaemia or other associated diabetes than without, depending on the region of the
conditions such as hypertension, polyneuropathic world and associated comorbidities.3 In the US, where
bladder dysfunction, and infections.1 People living diabetes-related CKD can be tracked at the national
with diabetes-related kidney disease are at higher level, its prevalence changed from 41% in 2005-2008 to
risk of cardiovascular disease (CVD), progression to 39.4% in 2017-March 2020.4 About 10% of adults with
kidney failure, and death. prediabetes had CKD stages three to four (estimated
glomerular filtration rate [GFR] 15 to 59 ml/min/1.73m²)
The number of new cases of CKD due to type 2 diabetes
in the latter period.5
increased worldwide from about 1.4 million in 1990
to 2.4 million in 2017, representing a 74% increase.2
The age-standardised incidence of diabetes-related CKD
was 29.15% per 100,000 in 2017.2 An increasing trend in
age-standardised CKD in type 2 diabetes is found in all
economic regions, with an inverse association between
An increasing trend in age-
CKD incidence and a country’s socio-demographic standardised CKD in type 2 diabetes
index.2 A decline in CKD incidence has been reported
among people with type 1 diabetes but not in those
is found in all economic regions,
with type 2 diabetes,3 indicating that the CKD burden is with an inverse association between
primarily related to the increasing prevalence of type 2
diabetes worldwide.
CKD incidence and a country’s
socio-demographic index.

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 Diabetes and kidney failure

In the adult population, diabetes remains a leading cause declined most markedly in Jalisco (Mexico) (-2.2 pmp),
of kidney failure, or end-stage kidney disease (ESKD),6 Iceland (-1.3 pmp), and Serbia (-1.0 pmp) 8 (Figure
a condition in which the kidneys no longer function and 1). National registry data from Australia indicate that
treatment with dialysis or transplantation is required for annual incidence of ESKD increased for people with type
survival. Globally, it is estimated that only 27% to 53% of 2 diabetes and remained stable in those with type 1
the population with ESKD has access to renal replacement diabetes during 2002-2013.9, 10
therapy, with its availability and access being particularly
Overall, prevalence of treated ESKD is 759 pmp, varying
deficient in low- and lower middle-income countries.7
from 966 pmp in high-income countries to 550.2 pmp
The highest incidence of treated ESKD attributable to
in upper-middle, 321 pmp in lower-middle, and 4.4 pmp
diabetes is found in some Asian countries and the US.8
in low-income countries. However, similar data on
Regardless of region, ESKD incidence is highest among
diabetes-related ESKD are not available.11 A recent survey
people with diabetes who are older than 65 years and
showed that the prevalence of diabetes in people with
male. Between 2010-2020, the largest average yearly
ESKD increased in most of the 142 countries studied.
increase in treatment for diabetes-related ESKD occurred
The global prevalence increased from 19% in 2000 to
in the Republic of Korea (9.7 per million persons [pmp]),
29.7% in 2015.12
Singapore (8.4 pmp), and Qatar (8.2 pmp), whereas it

Figure 1 – Average yearly change in incidence of treated ESKD attributed to diabetes,

by country and region, 2010-2020

Source: United States Renal Data System. 2022 USRDS annual data report: Epidemiology of kidney disease in the United States.
National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2022.

Diabetes and kidney disease – 2023 www.diabetesatlas.org | 5

 Reducing the burden of CKD in diabetes

The most effective strategy to reduce the burden In an effort to tackle the burden of CKD and diabetes,
of diabetes-related CKD is to delay or prevent type the International Diabetes Federation (IDF) and
2 diabetes and, among those already affected by International Society of Nephrology (ISN) developed
diabetes, to diagnose and treat CKD in its early stages. a policy brief “Renewing the fight: a call to action on
Screening for albuminuria or reduced GFR is cost- diabetes and chronic kidney disease”.17 The policy brief
effective in people with diabetes and hypertension.13, 14 provides recommendations on the actions required to
Screening for albuminuria is recommended yearly after prevent, manage and treat this condition effectively.
diagnosis of type 2 diabetes, and the same after the
first five years in people with type 1 diabetes.15
Both diabetes and CKD are strongly associated with
CVD and, therefore, controlling blood glucose and blood
pressure can reduce the risk of both CVD and CKD.
The availability of newer treatments to manage diabetes
that also prevent albuminuria and slow the decline of
renal function (glucagon-like peptide-1 receptor agonists
Guidelines and policies for screening
and sodium-glucose co-transporter 2 inhibitors) hold are possible to implement in high-
promise for changing the landscape of CKD in diabetes.
income countries, whereas countries
Guidelines and policies for screening are possible to
implement in high-income countries, whereas countries
with lower socioeconomic status,
with lower socioeconomic status, that experience that experience the largest increase
the largest increase in diabetes prevalence and have
additional unique risk factors for CKD, remain at
in diabetes prevalence and have
highest risk for CKD. This is due to limited capacity for additional unique risk factors for
screening, risk stratification and treatment, leading to
disproportionately high death rates and disability.16
CKD, remain at highest risk for CKD.

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 References

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Risk of infection in type 1 and type 2 diabetes compared with the Rosas SE, Rossing P, Bakris G. Diabetes management in chronic
general population: a matched cohort study. Diabetes Care. 2018 kidney disease: A consensus report by the American Diabetes
Mar; 41(3):513-521. DOI:10.2337/dc17-2131. Association (ADA) and Kidney Disease: Improving Global
2 Li H, Lu W, Wang A, Jiang H, Lyu J. Changing epidemiology of Outcomes (KDIGO). Diabetes Care. 2022 Dec 1; 45(12):3075-3090.
chronic kidney disease as a result of type 2 diabetes mellitus 16 Kalyesubula R, Conroy AL, Calice-Silva V, Kumar V, Onu U,
from 1990 to 2017: estimates from global burden of disease Batte A, Kaze FF, Fabian J, Ulasi I. Screening for kidney disease
2017. J Diabetes Investig. 2021 Mar; 12(3):346-356. DOI:10.1111/ in low- and middle-income countries. Semin Nephrol. 2022 Sep;
jdi.13355. 42(5):151315. DOI:10.1016/j.semnephrol.2023.151315.
3 Koye DN, Magliano DJ, Nelson RG, Pavkov ME. The global 17 The International Diabetes Federation (IDF) and the
epidemiology of diabetes and Kidney Disease. Adv Chronic International Society of Nephrology (ISN). Policy brief “Renewing
Kidney Dis. 2018 Mar; 25(2):121-132. DOI:10.1053/j. the fight: a call to action on diabetes and chronic kidney disease”.
ackd.2017.10.011. The International Diabetes Federation (IDF) and the International
4 USRDS. CKD in the general population. USRDS; 2020. Available Society of Nephrology (ISN); 2023. Available from: https://idf.
from: https://usrds-adr.niddk.nih.gov/2022/chronic-kidney- org/what-we-do/advocacy/resources/.
disease/1-ckd-in-the-general-population.
5 CDC. Prevalence of CKD stages 3-4, by diabetes and prediabetes.
CDC; 2020. Available from: https://nccd.cdc.gov/ckd/detail.
aspx?Qnum=Q702&topic=1#refreshPosition.
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report: Epidemiology of kidney disease in the United States.
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Digestive and Kidney Diseases, Bethesda, MD, 2022. Figure 11.5.
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McDonald SP, Polkinghorne KR, White S, Paul C, Shaw JE. Trends
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14 Shlipak MG, Tummalapalli SL, Boulware LE, Grams ME, Ix JH,
Jha V, Kengne AP, Madero M, Mihaylova B, Tangri N, Cheung M,
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