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ESRD incidence decreasing in type 1 diabetes
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The cumulative risk for end-stage renal disease among Finnish adults with type 1 diabetes has decreased markedly in the past 50 years, likely due to improvements in therapeutic regimens, according to findings published in Diabetes Care.
“We have shown here that the risk of ESRD has decreased continuously over time and that the progression of diabetic nephropathy and renal failure is slower than before among patients with type 1 diabetes,” Jaakko Helve, MD, PhD, of the Finnish Registry for Kidney Diseases in Helsinki, and colleagues wrote. “However, type 1 diabetes is still a notable cause of ESRD, and those with type 1 diabetes comprised 14% of all patients who entered [renal replacement therapy] in Finland in 2011-2015.”
Helve and colleagues analyzed data from 29,906 patients who began insulin therapy before age 30 years between 1965 and 2011, identified through the Diabetes in Finland II study (58% men; median age at diagnosis, 13 years; median follow-up time after diagnosis, 20.3 years). ESRD was defined as the onset of renal replacement therapy, based on linked information from the Finnish Registry for Kidney Diseases; information on deaths was obtained through the Cause of Death Register. Researchers followed patients from the start of insulin therapy through start of renal replacement therapy, death or Dec. 31, 2013, and used Cox proportional hazard models to assess the RRs for ESRD and death in the cohort.
During 616,403 patient-years of follow-up, researchers observed 1,543 cases of ESRD and 4,185 deaths.
For patients diagnosed between 1965 and 1969, the incidence rate of ESRD rose on average 15 years after a diagnosis of diabetes, with incidence rate continuing to increase up to 25 years after a diabetes diagnosis, before reaching a plateau through the end of follow-up. However, the incidence rate of ESRD at 16 to 20 years after diagnosis has become lower over time, according to researchers.
For the total cohort, at 20 years after diagnosis, cumulative incidence of ESRD was 2.2%, rising to 7% at 30 years after diagnosis. After excluding patients diagnosed with diabetes before 1980, however, cumulative incidence of ESRD fell to 1.3% at 20 years after diagnosis and 4.4% at 30 years after diagnosis.
Cumulative incidence of ESRD at 30 years after diagnosis was higher among men vs. women (7.7% vs. 6%). Patients diagnosed with diabetes before age 5 years had the lowest cumulative incidence of ESRD. After excluding patients diagnosed with diabetes before 1980, cumulative ESRD incidence was second lowest among patients diagnosed with diabetes aged 5 to 9 years until 25 years of follow-up.
“Because modern treatment of diabetes has been a mainstay only for less than 20 years, we will see if the risk of end-stage renal disease decreases still in the future,” Helve told Endocrine Today. “Research on effect of long-term use of different insulin regimens and renin-angiotensin system inhibitors on progression of diabetic nephropathy would provide important information.”– by Regina Schaffer
For more information:
Jaakko Helve, MD, PhD, can be reached at Helsinki University Hospital Abdominal Center, P.O. Box 340, 00029 HUS, Finland; email: jaakko.helve@helsinki.fi.
Disclosures: The authors report no relevant financial disclosures.
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