The growing economic burden of diabetic kidney disease.

Diabetes, a cardinal cause of chronic kidney disease, is the most common cause of end-stage renal disease. In the Medicare program, non-dialysis-requiring chronic kidney disease, diabetes, and congestive heart failure account for close to two thirds of all costs, and 4.2% of individuals with diabetes and chronic kidney disease account for 13.4% of expenditures. Diabetes is present in approximately 60% of new dialysis patients in the United States, and although the prevalence of renal replacement therapy remains comparatively low, rising prevalence rates may have substantial economic implications, especially when one considers that renal replacement therapy accounts for about 6% of current Medicare expenditures. Among dialysis patients, the presence of diabetes is associated with expenditures that are approximately 27% higher than in patients without diabetes. Interventions that successfully prevent the development or progression of both conditions have the potential to substantially reduce global health care costs.