The contribution of increased diabetes prevalence and improved myocardial infarction and stroke survival to the increase in treated end-stage renal disease

This study examined the extent to which the greater than threefold increase in number of treated end-stage renal disease (ESRD) cases between 1978 and 1991 is explained by increases in the prevalence of diabetes, myocardial infarction (MI) and stroke survivors, and US population size. The change in number of persons in the United States with diabetes, a history of MI or stroke, and without these conditions was estimated for 1978 and 1991 using the Second and Third National Health and Nutrition Examination Surveys. The treated ESRD incidence rate and the increase in ESRD treatment attributable to each of these populations were calculated using these estimates and data from the United States Renal Data System. In the United States, there were an estimated 4.3 and 1.2 million more persons with diabetes and a history of MI or stroke, respectively, 22.7 million more persons without these conditions, and 36,881 more incident treated ESRD cases in 1991 compared with 1978. In 1991, treated ESRD incidence rates among persons with diabetes, a history of MI or stroke, and without these conditions were 2567, 1463, and 153 cases per million person-years, respectively. In 1991, 10,183 cases of the additional 36,881 treated ESRD cases (27.6%) resulted from the higher prevalence of diabetes; 1775 (4.8%) from increased MI and stroke survival; and 2904 (7.9%) resulted from growth of the US population without these conditions. The increasing number of treated ESRD cases in the United States is partly explained by the increase in diabetes prevalence and US population growth but only minimally by MI and stroke survival.