Dialysis therapyIncidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: a report from the allegheny county registry
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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2020, Diabetes Research and Clinical PracticeCitation Excerpt :A limitation of this observational study, however, was that the definition of ESRD was only based on the initiation of dialysis or transplantation due to chronic renal failure, as data on estimated glomerular filtration rate (eGFR) were not available. In comparison, data from the U.S. estimated an incidence of ESRD of 9.3–11.3% 25 years after the T1DM diagnosis [24,25], data from Finland demonstrated an incidence of around 7.0–7.8% 30 years after the T1DM diagnosis [26,27] and data from Sweden showed a cumulative incidence of around 5.6% after up to 38 years of T1DM duration [28]. Risk factors for DKD are multifarious and include (1) susceptibility factors like age, race/ethnicity, sex and genetic risk factors, (2) initiation factors like hyperglycaemia, and (3) progression factors like hypertension or obesity [29].
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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.).