Year: 2026 | Month: June | Volume: 13 | Issue: 6 | Pages: 490-506
DOI: https://doi.org/10.52403/ijrr.20260648
How Diabetes Mellitus Leads to Dialysis: A Narrative Review
Mohammad Talat Ul Tuba Dar1, Dohu Rita Dui2, Sapana Gurung3
1Assistant Professor, Adesh Institute of Allied and Health Care Professions,
Adesh University, Bathinda, Punjab, India.
2Intern, Department of Dialysis Technology, Adesh Institute of Allied and Health Care Professions,
Adesh University, Bathinda, Punjab, India.
3 Intern, Department of Pharmacy, Adesh Institute of Pharmacy and Biomedical Sciences,
Adesh University, Bathinda, Punjab, India.
.
Corresponding Author: Mohammad Talat Ul Tuba Dar
ABSTRACT
Background: Diabetes mellitus is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) worldwide, accounting for a substantial proportion of patients requiring dialysis or kidney transplantation. The increasing global prevalence of diabetes has resulted in a parallel rise in diabetic kidney disease (DKD), creating a significant clinical and public health burden. Understanding the mechanisms that drive progression from diabetes to dialysis is essential for improving prevention and management strategies.
Objective: This narrative review aims to examine the pathophysiological mechanisms underlying diabetic kidney disease, describe its clinical progression from early renal injury to dialysis-dependent kidney failure, and evaluate current and emerging therapeutic approaches designed to delay or prevent progression to end-stage kidney disease.
Methods: A comprehensive narrative review of contemporary literature, clinical practice guidelines, landmark clinical trials, and nephrology reference sources was conducted. Evidence relating to the epidemiology, pathogenesis, diagnosis, progression, prevention, and management of diabetic kidney disease was synthesized to provide an integrated overview of the disease continuum.
Results: Chronic hyperglycemia initiates a complex cascade of metabolic and hemodynamic disturbances, including glomerular hyperfiltration, activation of the renin–angiotensin–aldosterone system, oxidative stress, inflammation, formation of advanced glycation end-products, and progressive renal fibrosis. These mechanisms contribute to albuminuria, declining glomerular filtration rate, chronic kidney disease progression, and ultimately end-stage kidney disease requiring renal replacement therapy. Early detection through albuminuria screening and estimated glomerular filtration rate assessment remains critical for identifying patients at risk. Contemporary therapeutic strategies, including optimized glycemic control, blood pressure management, renin–angiotensin system blockade, sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and non-steroidal mineralocorticoid receptor antagonists such as finer none, have significantly improved renal and cardiovascular outcomes and reduced progression to dialysis.
Conclusion: Diabetic kidney disease remains a major cause of kidney failure and dialysis worldwide. Early diagnosis, aggressive risk factor modification, and implementation of evidence-based Reno protective therapies are essential for slowing disease progression. Recent therapeutic advances have transformed the management of DKD and offer new opportunities to delay or prevent dialysis-dependent kidney failure. Continued research into precision medicine, regenerative therapies, and novel molecular targets may further improve outcomes and reduce the global burden of diabetic kidney disease.
Keywords: Albuminuria; Chronic kidney disease; Diabetes mellitus; Diabetic kidney disease; Diabetic nephropathy; Dialysis; End-stage kidney disease; Finerenone; GLP-1 receptor agonists; Renal replacement therapy; SGLT2 inhibitors. .
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