Incidence of End-stage Renal Disease in Patients With Type 1 Diabetes

Abstract

Context End-stage renal disease (ESRD) is one of the most severe complications of type 1 diabetes. Yet, data on patients' risk of developing ESRD are sparse. Objectives To estimate the long-term risk of developing ESRD and to assess how age at diagnosis of diabetes, time period of diagnosis, and sex affect the risk. Design, Setting, and Patients A cohort of all patients younger than 30 years diagnosed as having type 1 diabetes in Finland in 1965-1999 (n=20 005) was identified from the Finnish Diabetes Register. The cohort was followed up from diagnosis of diabetes until development of ESRD (dialysis or kidney transplantation as identified from the Finnish Registry for Kidney Diseases), death, or end of follow-up on December 31, 2001. Main Outcome Measure Cumulative incidence of ESRD, accounting for death as a competing risk. Results The cohort was followed up for maximally 37 years, with a median of 16.7 years. During 346 851 person-years, 632 patients developed ESRD. The cumulative incidence of ESRD was 2.2% at 20 years and 7.8% at 30 years after diagnosis. The risk of developing ESRD was lowest in patients whose diagnosis occurred at younger than 5 years. The risk of ESRD was lower for patients diagnosed as having type 1 diabetes in later years. The risk did not differ significantly between sexes. Conclusions With regard to ESRD, the prognosis of type 1 diabetes has improved during the past 4 decades. Children diagnosed as having diabetes before age 5 years have the most favorable prognosis. Overall, incidence of ESRD appears to be lower than previously estimated.

Age at Onset and the Risk of Proliferative Retinopathy in Type 1 Diabetes

“…This observation is in line with earlier findings regarding diabetic retinopathy and nephropathy (7,8,14). However, the long-term risk of proliferative retinopathy is no different between age-at-onset groups 0–4 and 5–14 years despite the initial advantage for those with earlier onset of diabetes.…”

Age at Onset and the Risk of Proliferative Retinopathy in Type 1 Diabetes

“…This observation is in line with earlier findings regarding diabetic retinopathy and nephropathy (7,8,14). However, the long-term risk of proliferative retinopathy is no different between age-at-onset groups 0–4 and 5–14 years despite the initial advantage for those with earlier onset of diabetes.…”

Risk for End-Stage Renal Disease Over 25 Years in the Population-Based WESDR Cohort

“…The current investigation therefore sought to provide much-needed information on the prevalence and incidence of ESRD and associated risk specific to people with type 1 diabetes. Consistent with a few previous studies (5,7,8), we observed decreased prevalence and incidence of ESRD among individuals with type 1 diabetes diagnosed in the 1970s compared with prior to 1970. The Epidemiology of Diabetes Complications (EDC) Study, another large cohort of people with type 1 diabetes followed over a long period of time, reported cumulative incidence rates of 2–6% for those diagnosed after 1970 and with similar duration (7), comparable to our findings.…”

“…In agreement with some but not all studies, males were at greater risk for ESRD than females (5,6,33,34). Poorer control of modifiable risk factors, including glycemic and blood pressure levels, may have attenuated some of the excess risk (34), reported in a prior WESDR investigation of renal insufficiency through 10 years of follow-up (19).…”

The importance of low HbA1c during childhood on glycaemic control in adulthood and the risk of late complications

“…Some studies have indicated that patients with onset before 10 years of age have lower rates of albuminuria and retinopathy. 30,31 The results in this study are to a higher degree consistent with the finding of Olsen et al 27 that onset of diabetes before puberty also contributed to these complications. diabetes could not be determined, although renal dysfunction is rare during childhood.…”

Age at Onset and the Risk of Proliferative Retinopathy in Type 1 Diabetes

“…This observation is in line with earlier findings regarding diabetic retinopathy and nephropathy (7,8,14). However, the long-term risk of proliferative retinopathy is no different between age-at-onset groups 0–4 and 5–14 years despite the initial advantage for those with earlier onset of diabetes.…”

Risk for End-Stage Renal Disease Over 25 Years in the Population-Based WESDR Cohort

“…The current investigation therefore sought to provide much-needed information on the prevalence and incidence of ESRD and associated risk specific to people with type 1 diabetes. Consistent with a few previous studies (5,7,8), we observed decreased prevalence and incidence of ESRD among individuals with type 1 diabetes diagnosed in the 1970s compared with prior to 1970. The Epidemiology of Diabetes Complications (EDC) Study, another large cohort of people with type 1 diabetes followed over a long period of time, reported cumulative incidence rates of 2–6% for those diagnosed after 1970 and with similar duration (7), comparable to our findings.…”

“…In agreement with some but not all studies, males were at greater risk for ESRD than females (5,6,33,34). Poorer control of modifiable risk factors, including glycemic and blood pressure levels, may have attenuated some of the excess risk (34), reported in a prior WESDR investigation of renal insufficiency through 10 years of follow-up (19).…”

The importance of low HbA1c during childhood on glycaemic control in adulthood and the risk of late complications

“…Some studies have indicated that patients with onset before 10 years of age have lower rates of albuminuria and retinopathy. 30,31 The results in this study are to a higher degree consistent with the finding of Olsen et al 27 that onset of diabetes before puberty also contributed to these complications. diabetes could not be determined, although renal dysfunction is rare during childhood.…”

Age at Onset and the Risk of Proliferative Retinopathy in Type 1 Diabetes

“…This observation is in line with earlier findings regarding diabetic retinopathy and nephropathy (7,8,14). However, the long-term risk of proliferative retinopathy is no different between age-at-onset groups 0–4 and 5–14 years despite the initial advantage for those with earlier onset of diabetes.…”

Risk for End-Stage Renal Disease Over 25 Years in the Population-Based WESDR Cohort

“…The current investigation therefore sought to provide much-needed information on the prevalence and incidence of ESRD and associated risk specific to people with type 1 diabetes. Consistent with a few previous studies (5,7,8), we observed decreased prevalence and incidence of ESRD among individuals with type 1 diabetes diagnosed in the 1970s compared with prior to 1970. The Epidemiology of Diabetes Complications (EDC) Study, another large cohort of people with type 1 diabetes followed over a long period of time, reported cumulative incidence rates of 2–6% for those diagnosed after 1970 and with similar duration (7), comparable to our findings.…”

“…In agreement with some but not all studies, males were at greater risk for ESRD than females (5,6,33,34). Poorer control of modifiable risk factors, including glycemic and blood pressure levels, may have attenuated some of the excess risk (34), reported in a prior WESDR investigation of renal insufficiency through 10 years of follow-up (19).…”

The importance of low HbA1c during childhood on glycaemic control in adulthood and the risk of late complications

“…Some studies have indicated that patients with onset before 10 years of age have lower rates of albuminuria and retinopathy. 30,31 The results in this study are to a higher degree consistent with the finding of Olsen et al 27 that onset of diabetes before puberty also contributed to these complications. diabetes could not be determined, although renal dysfunction is rare during childhood.…”