[16] This additive risk is also observed with respect to all-cause PF-01367338 mortality: from the United States NHANES study, standardized 10 year cumulative all-cause mortality was 11.5% among those without diabetes or kidney disease, compared with 31.1% in the population with both diabetes and kidney disease.[8] In this study, diabetes was not in fact associated with a significant increase in all-cause mortality unless kidney disease was also present. Mortality risk in the diabetes population is strongly related to the

severity of DKD, and a large proportion of the diabetes population will die from kidney failure as an underlying or associated cause without ever having commenced treatment for ESKD. In Australia in 2007, among deaths attributed to diabetes as the underlying cause, kidney failure was the third most common associated cause of death (27% of deaths attributed to diabetes), after coronary heart disease (52%), and hypertensive diseases (31%). For diabetes reported as any cause of death (underlying or associated), the most common contributing causes of death were coronary heart disease (47%), hypertensive diseases (30%), heart failure (21%), kidney failure (21%) and cerebrovascular

disease (20%).[18] This corresponds to approximately 3000 Liproxstatin-1 cost deaths in Australia annually listing diabetes as a cause of death in association with kidney failure. The rate of mortality from diabetes in association with

kidney failure therefore vastly exceeds the incidence of treated ESKD. For the patients with diabetes that CYTH4 do commence renal replacement therapy, 10 year survival on dialysis is 12%; 10 year survival for the minority of DM-ESKD patients who receive a kidney transplant, however, is 65% (personal communication, P Clayton, ANZDATA). The presence and severity of CKD in diabetes is therefore a profound determinant of patient outcomes. Consistent with an increasing morbidity burden as kidney function deteriorates, per person health care costs for patients with diabetes increase dramatically with successive stages of DKD. Analysis of the Alberta Kidney Disease Network (Canada) found that the cumulative 5 year costs of caring for patients with diabetes varied from CA$25 316 for patients with eGFR >90 mL/min to $115 348 for patients not on dialysis with eGFR <15 mL/min. Patients without proteinuria incurred an adjusted mean 5 year cost of CA$24 531 per patient, compared with CA$ 28 435 for a patient with mild proteinuria, and $46 836 for a patient with heavy proteinuria.[19] Data from the AusDiab study have similarly shown that people with diabetes incur substantially greater health care costs than those without, and that costs are further increased among those with complications such as DKD.