Dialysis therapy
Incidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: a report from the allegheny county registry

Presented in poster form at the 61st Scientific Session of the American Diabetes Association, Philadelphia, PA, June 22-26, 2001.
https://doi.org/10.1016/S0272-6386(03)00414-1Get rights and content

Abstract

Background:

Little information is available regarding the long-term incidence of end-stage renal disease (ESRD) and survival after the introduction of renal replacement therapy (RRT) in patients with type 1 diabetes.

Methods:

We studied 1,075 patients with type 1 diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who comprise the Allegheny County population-based registry. Onset of ESRD was defined as the introduction of RRT (dialysis or transplantation).

Results:

Of 1,075 registrants, the living status of 975 patients (90.7%) and complication status of 798 patients (74.2%) were ascertained as of January 1, 1999. During the observation period, 104 patients (13.0%) developed ESRD, for an incidence rate of 521/100,000 person-years (95% confidence interval, 424 to 629). The cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant decline was observed in 20-year cumulative incidence rates of ESRD for patients diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%, and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients (28%) received dialysis alone, 44 patients (42%) received dialysis followed by kidney transplantation, 26 patients (25%) underwent successful transplantation alone, and 5 patients (5%) underwent a failed kidney transplantation followed by dialysis therapy. The cumulative survival rate 10 years after the introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy followed by kidney transplantation was significantly greater than that of dialysis therapy alone (P < 0.001). No difference was detected in survival between pancreas-kidney transplant recipients and kidney-alone transplant recipients (P = 0.7).

Conclusion:

The incidence of ESRD observed in this cohort has declined, probably reflecting the better glycemic and blood pressure control available since the early 1980s.

Section snippets

Methods

Allegheny County is located in southwestern Pennsylvania, which hosted a population of approximately 1.6 million in 1970 and 1.3 million in 2000, with Caucasians accounting for more than 80% of the population. The city of Pittsburgh is the seat of the county. Patients were identified from the type 1 diabetes incidence registry in Allegheny County, which was developed through periodic review of hospital records and validated by contact with pediatricians in the community.12 This cohort is a

Results

Of 1,075 registrants, living status of 975 registrants (90.7%) and complication status of 798 registrants (74.2%) were determined as of January 1, 1999. There were no statistically significant differences in frequencies by year of onset (P = 0.16) or sex (P = 0.70) between those traced and those missing on January 1, 1999, using chi-square test; however, mean age at onset was higher (11.5 ± 4.2 [SD] versus 10.7 ± 4.1 years; P = 0.003 by t-test) and the proportion who were Caucasian was lower

Discussion

This study, which is based on the type 1 diabetes registry of diagnosed cases between 1965 and 1979 from Allegheny County, shows a higher incidence of RRT among African Americans, but an encouraging decline in incidence for those diagnosed more recently. Although survival after RRT is greater with transplantation compared with dialysis therapy alone, these data do not permit a full evaluation because we have no details concerning the clinical state of patients at the onset of RRT. It is likely

Acknowledgements

The authors thank Ronald E LaPorte and Idamae Gower for extensive advice; Georgia Pambianco, Lesa Tomas, Nancy Silvers, and Cynthia Paoletti for their contribution in contacting patients; Takashi Okumura for computer programming; Robb Wilson and Yasushi Kanazawa for data management; and study participants and their families for their willing assistance.

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    Supported in part by a grant from the Imperial Boshi Aiikkukai Foundation; grant no. DK 34818 (Epidemiology of Diabetes Complication Study) from The National Institutes of Health; and a fellowship from the Uehara Memorial Foundation and the Imperial Boshi Aiikkukai Foundation (R.N.).

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