Data & Trends

Diabetes Surveillance System

1999 Surveillance Report

Chapter 1: The Public Health Burden of Diabetes Mellitus in the United States

End-Stage Renal Disease

Diabetes is the leading cause of end-stage renal disease (ESRD), i.e., kidney failure requiring dialysis or transplantation (25,26). In the United States, diabetes accounts for approximately 40% of all new cases. Persons with diabetes are the fastest growing group receiving kidney dialysis or transplantation. This report shows that ESRD remains a significant complication among persons with diabetes and that blacks and the elderly are disproportionately affected.

The number of persons who began treatment for ESRD attributable to diabetes (ESRD-DM) increased from 6,981 in 1984 to 31,647 in 1996 (Figure 8.1, Table 8.1). In 1984, the number of persons who began treatment for ESRD-DM increased with age up to 65 years and was highest among those aged 55-64 years (Figure 8.2, Table 8.2). In 1996, the number increased with age up to 75 years and was highest among those aged 65-74 years. Between 1984 and 1996, the age-adjusted incidence of ESRD-DM treatment per 100,000 persons with diabetes increased by more than 200%, from 117.4 to 378.1 (Table 8.20); among both blacks and whites, the relative increase was also greater than 200% (Figure 8.4, Tables 8.23 and 8.26). Throughout the period, the age-adjusted incidence of ESRD-DM treatment was greater among blacks than whites. In 1996, the age-adjusted incidence of treatment among blacks with diabetes was nearly two times that among whites with diabetes (590.3 vs. 312.1).

Between 1984 and 1996, incidence of ESRD-DM treatment per 100,000 persons with diabetes increased among all age groups, and the relative increase was greater with age (Figure 8.5, Table 8.20). Incidence of treatment increased by 44% among persons with diabetes aged <45 years, by 213% among persons aged 45-64 years, by 405% among persons aged 65-74 years, and by 644% among persons aged greater than or equal to 75 years. In 1984, persons with diabetes aged <45 years had the highest incidence of treatment for ESRD-DM. In 1996, however, persons with diabetes aged 45-74 years had a higher incidence of treatment than persons aged <45 years.

The age-adjusted incidence of ESRD-DM treatment increased by 291% in the general population and by 222% in the diabetic population (Tables 8.11 and 8.20). For each of these respective populations, the increases in the crude incidence of treatment (303% in the general population and 224% in the diabetic population) were similar to the increases in the age-adjusted incidence, suggesting that the increases in incidence were not due to the aging of the population. The increase in the diabetic population was 74% that of the general population, indicating that most of the increase in the general population is due to the increasing incidence of ESRD-DM in the diabetic population and that only 26% is due to the increasing prevalence of diabetes.

In 1996, incidence of treatment for ESRD-DM varied by state and ranged from 4.82 to 32.58 per 100,000 (Figure 8.6, Table 8.29). Incidence was higher among persons residing in the southeastern and southwestern states and Hawaii, followed by persons residing in the northeastern and midwestern states. Incidence was lower among persons residing in the northwestern and mountain states and Alaska.

These surveillance data do not allow us to determine the reasons for the increase in incidence of treatment for ESRD-DM. Reasons may include higher incidence of ESRD-DM, changes in treatment and care practices, greater recognition of the etiologic role of diabetes in ESRD, better access to or acceptance of treatment, or a combination of these factors.

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This page last reviewed January 18, 2005.

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation