Preventable kidney failure: the cost of diabetes neglect?

Diabetic kidney disease is currently responsible for 45% of new patients reaching end-stage chronic kidney disease in New Zealand. Since much of this may be prevented or deferred, we have made a preliminary analysis of the cost of diabetic nephropathy to New Zealand for those patients requiring renal replacement therapy (dialysis or transplantation).

Patient numbers were obtained from the Australian and New Zealand Dialysis and Transplant Registry and the Christchurch Hospital Nephrology database. Agreed costs were utilised for dialysis patients' average length of stay, and surgical costs of kidney transplantation were based on local estimates. National data were used for pharmaceutical costs.

The cost of renal replacement therapy in New Zealand is conservatively estimated at NZ90 million dollars annually (based on 2003 figures). Diabetic nephropathy is responsible for at least 36 million dollars in direct annual healthcare costs.

Primary or early secondary intervention strategies should be coordinated and implemented nationally. Renal indicator data from Get Checked and similar strategies must be made widely available to facilitate identification of early diabetic renal disease and allow coordinated intervention. These initiatives are now urgently required.