Epidemiology of diabetic nephropathy in Spain.
BACKGROUND
The incidence of diabetes mellitus (DM) has increased persistently in recent years and is becoming an epidemic. Some have estimated that 4.4% of the world's population will be diabetic by the year 2030. The increase incidence of DM has been accompanied by an increased incidence in diabetic nephropathy (DN), the main cause of end-stage renal disease.


RESULTS
In 1996, a pharmaco-economic study estimated that 162,000 people in Spain had type 1 DM and 1,354,900 had type 2 DM. More recent studies have estimated that 6% to 10% of the Spanish population might be diabetic. This percentage is higher in some autonomous communities, such as Canarias, in which 12% of the population is thought to have DM. Based on these studies, we estimate that more than 33,000 residents of Canarias have DN associated with type 1 DM, and more than 405,000 have DN associated with type 2 DM. The percentage of diabetic patients starting renal replacement therapy each year is currently around 21% in Spain but much higher (35%) in Canarias, which equates to 78 patients per million population (pmp) per year. In Catalonia, the number of DM patients entering renal replacement therapy has increased from 8.6 pmp per year in 1984 to 32.4 pmp per year in 2003. We estimate that the systematic application of converting enzyme inhibitors or angiotensin receptor blockers could save more than 2.690 million over 15 years in Spain.


CONCLUSIONS
This epidemic could be prevented, or its impact reduced, through multifactorial and multidisciplinary early intervention, under the observance of guides, Spanish consensus documents, and clinical practice recommendations, together with an integrated educational program aimed at people with diabetes and the improvement of the standard of medical care.
Martínez-Castelao
Alberto
A
Hospital Universitario Bellvitge, IDIBELL, Hospitalet Llobregat, Barcelona, Spain. amcastel@terra.es
De Alvaro
Fernando
F
Górriz
José Luis
JL
D003627:Data Interpretation, Statistical; D003695:Delivery of Health Care; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012084:Renin-Angiotensin System / Q000502:physiology; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology