Diabetes Poses Greatest Kidney Risk

By Kristina Fiore, Staff Writer, MedPage Today Published: May 31, 2013Note that these review articles report that chronic kidney disease is highly prevalent, and increasing worldwide. Be aware that aristolochic acid (a nephrotoxin) is a major cause of kidney disease in certain Asian countries, but can be found in herbal medicines worldwide. Diabetes is the most common cause of chronic kidney disease worldwide, though herbal and environmental toxins are also to blame, especially in developing countries, researchers found.Diabetes is behind at least a third of chronic kidney disease cases in countries such as the U.S., Australia, and Japan, Vivekanand Jha, MD, of the George Institute for Global Health in New Delhi in India, and colleagues wrote online May 31 in The Lancet.

But in countries such as Taiwan and China, many cases appear to be tied to aristolochic acid, a compound used to promote weight loss, they wrote in an article published as part of the journal's global series on kidney disease."Aristolochic-acid nephropathy is a progressive interstitial nephritis that leads to end-stage kidney disease and urothelial malignant disease," they wrote. "It was first reported in 1993, in young women who received a regimen containing an herb later identified as Aristolochia fangchi in Belgian slimming clinics. Epidemiological data from Taiwan and China show an association between use of herbs containing aristolochic acid and chronic kidney disease."Other herbal supplements in Asia and Africa are also thought to be the cause of many chronic kidney disease cases, they added: "In Asian countries, traditional medicines are very popular and pharmaceutical medicines are frequently substituted or supplemented by botanical products that include herbs containing aristolochic acid."In the report, the researchers found that Taiwan has the highest prevalence of end-stage kidney disease, at about 2,500 cases per million population, followed by Japan at about 2,300 cases and the U.S. at just under 2,000 cases per million population.Chronic kidney disease is also quickly working its way up the global cause of death league table, moving from number 27 in 1990 to 18 in 2010, the researchers reported.In a second study in the series, Kai-Uwe Eckardt, MD, of the University of Erlangen-Nürnberg in Germany, and colleagues noted that the global population prevalence of chronic kidney disease exceeds 10% in most countries, and is more than 50% in certain high-risk subpopulations.That prevalence increases with age, they wrote, exceeding 20% in patients over age 60 and topping 35% in those over 70.However, they noted that one in 25 patients age 20 to 39 also has chronic kidney disease, and black patients are twice as likely as white patients to develop it.Also, the highest prevalence of chronic kidney disease is in patients with diabetes and cardiovascular disease, reaching 50% or higher, they wrote.