Rates of diabetes-related ESRD appear to decrease in U.S., Puerto Rico

From 2000 to 2014, the age-standardized incidence of end-stage renal disease (ESRD) attributed to diabetes decreased from 260.2 to 173.9 per 100,000 diabetic population.


Rates of end-stage renal disease (ESRD) attributed to diabetes appear to have decreased in the U.S. and Puerto Rico from 2000 to 2014, according to federal data.

CDC researchers used data from U.S. Renal Data System and the Behavioral Risk Factor Surveillance System to determine whether ESRD attributed to diabetes continued to decrease in the U.S., the District of Columbia, and Puerto Rico from 2000 to 2014. Persons 18 years of age and older who began treatment for ESRD and for whom diabetes was listed as the primary ESRD cause were obtained from the U.S. Renal Data System, and noninstitutionalized persons who had diagnosed diabetes and were 18 years of age and older were obtained from the Behavioral Risk Factor Surveillance System. Incidence of ESRD attributed to diabetes was then calculated by dividing the number of patients starting ESRD treatment by the number of patients with diagnosed diabetes. Results were published Nov. 3 by Morbidity and Mortality Weekly Report.

A total of 120,000 patients started ESRD treatment in 2014, 44% with diabetes listed as the primary ESRD cause. From 2000 to 2014, the age-standardized incidence of ESRD attributed to diabetes decreased from 260.2 to 173.9 per 100,000 diabetic population (33%), with significant decreases seen in most states, in the District of Columbia, and in Puerto Rico. No increases in incidence rates were seen in any states, although California, Hawaii, Mississippi, and Montana did not have significant decreases. The incidence rate in 2000 was at least 217.5 per 100,000 persons with diabetes in 41 states, in the District of Columbia, and in Puerto Rico, and no state had a rate below 164.5 per 100,000 persons with diabetes. In 2014, however, only five states had an incidence rate of at least 217.5 per 100,000 persons with diabetes, and 24 states had a rate below 164.5 per 100,000 persons with diabetes.

The authors noted that data on ESRD treatment were based on cases reported to CMS, so incidence might have been underestimated, and that data on diabetes were based on self-report, among other limitations. However, they concluded that significant decreases were seen in age-standardized incidence of ESRD related to diabetes from 2000 to 2014. While surveillance data cannot be used to determine incidence, the authors hypothesized that rates of ESRD related to diabetes may have declined due to reductions in risk factors for kidney failure, such as hyperglycemia and hypertension, in patients with diabetes. Better treatment of kidney disease could also be a factor, they said. “Continued awareness and interventions to reduce the prevalence of risk factors for kidney failure, improve diabetes care, and reduce the incidence of type 2 diabetes might sustain these positive trends,” the authors wrote.