Persons with diabetes make up the largest single group of kidney failure patients requiring dialysis or transplant in the United States. The high count reflects the growth in diabetes prevalence and increased access to dialysis and transplantation. Kidney failure affects about 1% of persons with diabetes in the United States; a considerably higher proportion, about 40%, have less severe kidney disease. Based on data from the National Health and Nutrition Examination Surveys 2017–March 2020, 14% of adults age ≥20 years or an estimated 35.5 million individuals had chronic kidney disease (CKD), and 38.7% of adults with diabetes had CKD-defined single measurements of albuminuria and serum creatinine.
Improvements in the management of persons with diabetes and CKD have extended the time course from onset of severe albuminuria to kidney failure and reduced the occurrence of cardiovascular events. Newer antihyperglycemic treatment strategies with sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and the newer mineralocorticoid receptor antagonists (MRAs) have shown efficacy in slowing kidney disease progression and reducing cardiovascular outcomes, without increasing the risk of hypoglycemia. In addition, landmark studies have shown that persons with kidney disease associated with diabetes require multidisciplinary management involving a combination of treatments and behavioral adjustments to delay progression of CKD and to prevent the associated complications.