Most Common Cause of Chronic Kidney Disease
Diabetes is the most common cause of chronic kidney disease and end-stage kidney disease worldwide, accounting for 30-40% of cases in many countries and up to 60% of patients with end-stage kidney disease. 1, 2
Primary Etiologic Factors
Diabetes mellitus stands as the leading cause globally:
- Diabetic kidney disease (DKD) affects approximately 40% of patients with diabetes during their lifetime 1
- It is the single largest cause of kidney failure requiring dialysis or transplantation in the United States 1
- DKD can develop after 10 years in type 1 diabetes, but may already be present at diagnosis of type 2 diabetes 2
- The prevalence of CKD among people with diabetes exceeds 25% 1
Hypertension represents the second most common cause:
- It is one of the most frequent causes of CKD in developed countries 2
- Hypertension creates a dangerous bidirectional relationship—it both causes kidney damage and results from kidney disease, accelerating functional decline 2
- Approximately 70% of individuals with elevated serum creatinine have hypertension 2
Geographic and Population Variations
The relative contribution of causes varies by region:
- In China, chronic glomerulonephritis and diabetes together account for more than 50% of CKD cases 2
- In developed nations, diabetes and hypertension dominate as the primary causes 3, 4
- Glomerulonephritis remains a significant cause in certain regions, particularly where infectious diseases are more prevalent 2
Clinical Implications for Screening
Given diabetes as the predominant cause, screening strategies must be aggressive:
- All patients with diabetes should be screened annually using both urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) 1, 2
- Screening for type 2 diabetes must begin immediately at diagnosis, as 6.5% of newly diagnosed patients already have significant albuminuria and 28% already have hypertension 2
- Patients with hypertension should also undergo regular CKD screening, as the combination of diabetes and hypertension creates a metabolic syndrome phenotype that dramatically accelerates progression 2
Common Pitfall to Avoid
Do not assume diabetic kidney disease is the only cause in diabetic patients—up to 30% of patients with diabetes and CKD have other causes on kidney biopsy, necessitating evaluation for atypical features such as rapid progression, active urinary sediment, or absence of diabetic retinopathy 2