SP300RISK OF DEVELOPING END-STAGE RENAL DISEASE AFTER DIAGNOSIS OF TYPE 2 DIABETES

Abstract

INTRODUCTION AND AIMS: Almost 10% of the adult population in the world has diabetes. The number of patients with diabetes will grow to almost 600 million in 2035, and the vast majority has type 2 diabetes. End-stage renal disease (ESRD) is one of the most devastating complications of diabetes. Among patients entering chronic renal replacement therapy, type 2 diabetes is the most common cause of ESRD in most industrialized countries. However, very few studies have followed type 2 diabetes patients from time of diagnosis until the development of ESRD, and the long-term cumulative risk of ESRD is not well known. We aimed at estimating risk of ESRD in a complete nationwide cohort of patients with newly diagnosed type 2 diabetes and long followup. METHODS: Patients diagnosed with type 2 diabetes in 1990 to 2011 were identified from several national healthcare registries in Finland and gathered in the FinDM database. Virtually all inhabitants aged 40 years or older who started diabetes medication or were hospitalized for diabetes were included. ESRD was defined as renal replacement therapy as identified from the national renal registry. Cumulative risk of ESRD was estimated using methods that take death into account as a competing risk event. Hazard ratios of ESRD were calculated using proportional subdistribution hazards regression. RESULTS: During 1990-2011, 421 429 patients were diagnosed with type 2 diabetes and of these 1516 developed ESRD and 150 524 died before the end of 2013. Cumulative risk of ESRD was 0.29% at 10 years and 0.74% at 20 years from the diagnosis of type 2 diabetes. The risk of ESRD was higher among males than females (hazard ratio 1.93, 95% CI 1.72-2.16), and lower for those diagnosed with type 2 diabetes in 2000-2011 compared to 1990-1994 (hazard ratio 0.72, 95% CI 0.63-0.81). The cumulative risk of ESRD was lower among older patients because of increased competing mortality. CONCLUSIONS: Although type 2 diabetes is a very common cause of ESRD among patients who enter renal replacement therapy, type 2 diabetes patients' risk of developing ESRD is small especially when compared to their risk of dying without ESRD.