Chronic kidney disease (CKD) is a formidable and challenging condition. New cases and overall cases of end-stage renal disease (ESRD) continue to increase—a trend consistent with a predictive model developed as a U.S. Renal Data System project at the beginning of the decade. Although the total burden of CKD and ESRD has increased, the rate of increase in new cases has progressively decreased. After rising steadily during the 1980s and early 1990s, rates have become more stable, changing 2.5 percent or less in each year since 2000.¹ Type 2 diabetes remains the major driving force behind the development of CKD and ESRD and now accounts for about 45 percent of the new cases of ESRD.¹

CKD and ESRD are significant public health problems in the United States that affect increasing the quality and years of healthy life and eliminating health disparities. These diseases are responsible for premature death and exact a high economic price for both the private and public sectors of the United States, with select populations bearing a disproportionate burden.

Over the past 5 years, several studies have shown that proteinuria, especially in persons with diabetes, predicts faster progression of kidney disease to end stage.^{2, 3, 4, 5, 6, 7, 8, 9} These and other studies have further shown the effectiveness of drugs that modify the renin-angiotensin-aldosterone axis: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) reduce proteinuria and slow progression of established kidney disease. Although these drugs slow progression, they do not seem to halt it.

Using data from these studies, the National Kidney Foundation (NKF) and the American Diabetes Association (ADA) have developed guidelines for improved care and quality of life for persons with diabetes and kidney disease. The National Diabetes Education Program (NDEP) and the National Kidney Disease Education Program (NKDEP) have launched initiatives to better educate both health care providers and patients on improved care.¹⁰

The National Institute of Diabetes and Digestive and Kidney Diseases' (NIDDK's) Diabetes Prevention Program shows that moderate exercise, a healthier diet, and weight reduction can prevent development of type 2 diabetes in persons at risk.¹¹ Furthermore, all racial and ethnic groups have benefited equally from these lifestyle modification programs.¹¹ Based on these results, voluntary organizations and many communities around the country also have launched programs aimed at healthier lifestyles to prevent diabetes.¹² These initiatives, community programs, and guidelines hold the potential to reduce kidney disease burden, lengthen lives, improve quality of life, and eliminate disparities among patients with kidney disease.