No, Having ESRD Does Not Automatically Mean You Have Diabetes
While diabetes is the leading cause of ESRD in the United States, accounting for approximately 40% of new ESRD cases, this means that roughly 60% of ESRD patients do NOT have diabetes. 1, 2
Understanding the Relationship Between ESRD and Diabetes
Diabetes as a Cause of ESRD
- Diabetes is the single most common cause of ESRD in the U.S. and Europe, but it is not the only cause 1
- Among patients starting dialysis, diabetic nephropathy accounts for about 40% of cases, leaving 60% attributed to other causes 1, 2
- In the U.S. Renal Data System registry from 1998,48.4% of new ESRD cases were attributed to diabetes, meaning 51.6% had non-diabetic causes 1
Other Common Causes of ESRD
The evidence clearly indicates that ESRD develops from multiple etiologies beyond diabetes, including: 1
- Hypertensive nephrosclerosis
- Glomerulonephritis
- Polycystic kidney disease
- Obstructive uropathy
- Other primary kidney diseases
Important Clinical Distinction
Only 20-30% of patients with type 1 or type 2 diabetes actually develop nephropathy, and an even smaller fraction progress to ESRD. 1 This demonstrates that:
- Not all diabetics develop ESRD
- Not all ESRD patients have diabetes
- The relationship is unidirectional: diabetes can cause ESRD, but ESRD does not cause diabetes
Key Pitfall to Avoid
Do not assume a patient with ESRD has diabetes without proper diagnostic confirmation. 2 While diabetic patients with ESRD have specific management considerations (including higher mortality rates and more comorbid conditions), non-diabetic ESRD patients require different evaluation and treatment approaches. 1, 3
Clinical Implications
- Always evaluate the underlying cause of ESRD in each patient 2
- Screen for diabetes in ESRD patients, but do not presume its presence 4
- Non-diabetic ESRD patients can develop hypoglycemia from other causes (adrenal insufficiency, malnutrition, medications, infection) that require different management 4