By comparison, of the chronic kidney disease (CKD) population without diabetes, an estimated 24% have an eGFR<60 mL/min per 1.73 m2 in the absence of albuminuria. The proportion of the diabetes

population with normoalbuminuric CKD, however, increases with older age and is affected by the proportion of patients receiving treatment with ACE inhibitors and angiotensin receptor blockers (ARB).[6, 7] Thus, as the demographics and the management of the diabetes population in Australia change, so will the distribution of markers of kidney damage in this population. Longitudinal surveillance of the diabetes population Cell Cycle inhibitor in the United States has shown evidence of such trends. find more Comparing NHANES survey data for 1988–1994 to data for 2005–2010, albuminuria prevalence in the diabetes population declined from 36% to 30% over this period, whereas the prevalence of eGFR<60 mL/min per 1.73 m2 increased from 16% in 1988–1994 to 19% in 2005–2010.[8] These observations are indicative of competing trends that will have important

implications for the future burden of DKD in the Australian population: (i) the ageing of the diabetes population due to increasing incidence of late onset T2DM and improved survival among the diabetes population, increasing the prevalence of low eGFR, and (ii) the impact of either increased use of ACE inhibitors and ARB on albuminuria prevalence. The distribution of markers of CKD in the population with diabetes has important implications for approaches to screening and disease prevention, and therefore an understanding of temporal trends in the prevalence of albuminuria and low eGFR is necessary to guide

approaches to detection and management of DKD. Of the approximately 250 000 Australians with DKD, 913 commenced treatment for ESKD with a primary diagnosis of diabetic nephropathy in 2012. These figures correspond to an annual incidence of treated DM-ESKD among Australian adults 25 years and older with diabetes (diagnosed and undiagnosed) of approximately 1 case per thousand. Over the past two decades, DKD has rapidly emerged as the single leading cause of ESKD among patients commencing kidney replacement therapy (KRT) in Australia (Fig. 1). Of all incident KRT patients in 2012, 38% had a primary diagnosis of DM-ESKD, compared with 13% in 1991. Indeed most of the overall increase in the annual number of patients commencing KRT, from 979 new patients in 1991 to 2379 patients in 2012, is due to the more than 600% increase in the number of incident patients with DM-ESKD over this period. This growth in DM-ESKD incidence cannot be explained by demographic factors: after adjusting for age, sex and race, the incidence of KRT due to DM-ESKD still increased by 7% per annum.