Diabetes-related renal complications: Insights on the impact of diabetic kidney disease on mortality

Abstract

Diabetes mellitus (DM) is a major contributor to disability and mortality, accounting for nearly 10% of all deaths in people aged 20 to 79 years. In addition, the increasing prevalence of diabetes has significantly increased the burden of disease across multiple facets of the disease spectrum. Diabetic kidney disease (DKD) is an important factor affecting morbidity and mortality in people with diabetes. DKD is characterized by a gradual deterioration of kidney function leading to end-stage renal disease (ESRD) in up to 50% of cases in certain populations and increased susceptibility to cardiovascular events. DKD is generally characterized by chronic kidney disease (CKD) defined by persistently (at least 3 months) elevated urinary albumin excretion (albumin-to-creatinine ratio ≥ 30 mg/g) and/or decreased estimated glomerular filtration rate (estimated glomerular filtration rate < 60 mL/minute/1.73 m²) in people with diabetes. As glomerular filtration rate decreases and albuminuria increases, the likelihood of adverse outcomes such as mortality and ESRD increases. People with a GFR ≤ 30 mL/minute/1.73 m² have a significantly increased risk in all categories of albuminuria. It is of pivotal importance to understand the pathophysiology of DKD, its gradual progression and the significant impact on mortality in diabetic patients. Early detection and optimal glycemic and blood pressure control are crucial to counteract the progression of the disease. Another important aspect is to identify the population group at greatest risk of diabetic-related deterioration of kidney function and prevent disease progression. There is an urgent need for thorough treatment strategies that address both renal and cardiovascular risk factors to reduce the strikingly high mortality rate closely associated with DKD in diabetics.

Keywords: Kidney diseases; Mortality; Chronic disease; Diabetic kidney disease; Diabetes mellitus

Core Tip: Diabetic kidney disease (DKD) is a major microvascular consequence of diabetes mellitus and a major factor in the progression of chronic kidney disease worldwide. In addition to its contribution to end-stage kidney disease, DKD significantly associated with increased all-cause and cardiovascular mortality. Epidemiological studies have consistently shown that even the early stages of DKD, characterized by microalbuminuria or a slight reduction in estimated glomerular filtration rate, are associated with an increased risk of mortality. The results of the current literature highlight the significance of early detection and vigilant oversight and management of DKD patients.