Epidemiology of kidney failure in diabetic patients in Italy

Chronic renal failure represent one of the more common complications of diabetes. End-stage renal disease develops in about 50% of type 1 (insulin-dependent) diabetic patients between 10 and 30 years from the onset of the disease, and in a consistent number of type 2 (non-insulin-dependent) diabetic patients. In the past, diabetic patients were not included in dialysis programmes, but in the 1980s, in Western countries, a progressively increasing number of them were accepted for renal replacement therapy (RRT). According to the EDTA (European Dialysis and Transplantation Association) Registry, the prevalence of diabetic patients in the dialysis population in Europe varies consistently from country to country (6.8% in France, 9% in Southern Europe, 16% in Germany and 34% in Finland). In Italy, according to the ANED (National Association of Dialysed Patients) Registry, at the end of 1990 1929 of 27106 patients (7.11%) were classified as diabetic. A survey of the diabetic population on RRT was suggested by Catalano in 1988. Palatients were classified as having type 1 diabetes if they required insulin therapy at the start of diabetes or within 2 years of the onset of the disease. The data obtained showed that in Italy the ratio of type 1 to type 2 patients on RRT was 1:3. Another inmportant observation of this survey was that 79% of diabetic patients on RRT were affected by diabetic nephropathy and 21% by other nephropathies complicated by diabetes. About 50% of diabetic patients on RRT in Italy suffered from micro-and macroangiopathy before the start of replacement therapy. It is interesting that in the southern regions of the country the proportion of type 2 diabetic patients was greater than in the north, and that in Sardinia (probably as a result of genetic factors) 71% of diabetics on RRT had type 1 diabetes. In Italy the most common dialysis modality was haemodialysis (81%), while peritoneal diaysis accounted for 14% of patients; only 5% of diabetic patients received a functioning graft. Kidney transplantation should be considered the best form of RRT for diabetic patients, but very few transplants are performed in Italy, mainly as a result of organi procurement problems. More recent data indicate that the number of diabetic patients accepted for RRT is progressively increasing and that about 10 new diabetic patients pmp/year enter Italian RRT programmes. Diabetic patients on RRT have a shorter survival than the general dialysis population and suffer from many important complications. However, their life expectancy, which was very poor in the last decade, is now progressively improving.