However, in contrast to the increasing prevalence of diabetes and early stages of DKD, recent trends in the incidence find more of DM-ESKD suggest that better management in the earlier

stages of DKD has been successful in slowing rates of disease progression. Simultaneous improvements in use of renin–angiotensin inhibitors and improved glycaemic and blood pressure control are likely to be largely responsible for this trend. Primary prevention, maximizing early detection of DKD and optimal management of diabetes and kidney disease hold great potential to attenuate the future health burden attributable to DKD in Australia. Diabetes-related kidney disease (DKD) may be defined as the presence of persistent albuminuria, proteinuria and/or estimated glomerular filtration rates (eGFR) <60 mL/min per 1.73 m2 in a person with diabetes. As is the case in the non-diabetic population, both albuminuria and reduced eGFR are independently associated this website with increased risk of premature cardiovascular and all-cause mortality, and risk of progression to end-stage kidney disease (ESKD). The magnitude of this risk is proportional to the magnitude of the abnormality for both parameters, and is significantly greater in those with diabetes compared with those without.[1] Based on data from the United Kingdom Prospective Diabetes Study (UKPDS), conducted between 1977 and 1997, one quarter of the population with type 2

diabetes (T2DM) will develop albuminuria within 10 years of diabetes diagnosis.[2] This is consistent with earlier studies of the development of DKD in T1DM patients, showing onset at approximately 5–10 years post-diagnosis and peaking at 10–19 years diabetes duration.[3, 4] Younger age at diagnosis increases the probability of developing DKD over the life course, whereas the risk of reaching ESKD for those diagnosed with diabetes later in life may be relatively low.[2] Over the past two decades, increasing diabetes prevalence in Australia has produced a commensurate increase in the number of adults

with DKD and diabetes-related Dolichyl-phosphate-mannose-protein mannosyltransferase ESKD (DM-ESKD). Here we review the current and the potential future burden of DKD and DM-ESKD in Australia, taking into account evolving practices in diabetes management and incidence trends in other high-income countries. The baseline AusDiab Study conducted in 1999/2000 found that among Australian adults (25 years and older) with diabetes, 27% had evidence of DKD (Table 1). These data suggest that approximately a quarter of a million Australians have DKD, and because of this are at high risk of progression to DM-ESKD, cardiovascular events and premature death. By comparison, the prevalence of DKD in the United States diabetic population was 40%, according to the results of the 2005–2010 NHANES survey.[5] Based on AusDiab data, the vast majority (94%) of the adult DKD population exhibited albuminuria, either alone or in combination with a low estimated eGFR.