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ESKD on the rise among nonindigenous Australians with type 2 diabetes
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Between 2002 and 2013, the annual incidence of ESKD increased among nonindigenous Australians with type 2 diabetes but was stable for those with type 1, according to a study published in American Journal of Kidney Diseases.
Researchers stated that the most recent leading cause of ESKD is diabetes. In the diabetic populations of developed countries, age-standardized rates of cardiovascular events, mortality and amputations have declined significantly.
Declines in ESKD incidence in the United States, however, have been much more modest.
“It is probable that improvements in diabetes management for the secondary prevention of ESKD have been offset by the reduction in competing risks for mortality,” Digsu N. Koye, PhD, of the department of clinical diabetes and epidemiology at Baker Heart and Diabetes Institute and the department of epidemiology and preventive medicine at Monash University in Melbourne, and colleagues wrote in the study introduction. “[That] is, persons with diabetes are living longer, increasing their chance of developing ESKD during their life course.”
Investigators concluded that to understand temporal trends in renal outcomes among diabetic populations, it would be necessary to calculate ESKD incidence using a population-representative diabetes cohort, rather than analyzing standalone kidney disease registries.
Researchers used the National Diabetes Services Scheme, a registry of diagnosed diabetes cases in Australia, as well as the Australian and New Zealand dialysis and transplant registry to identify all incident ESKD cases from 2002 to 2013. They analyzed any variation in incidence according to age, sex, diabetes type, socioeconomic disadvantage or geographic remoteness, and calculated the incidence of ESKD in those younger than 55 years with type 1 diabetes.
Of the 1,375,877 individuals on the registries, 9,977 experienced incident ESKD. This represents an overall incidence of 10 (95% CI, 9.8-10.2) per 10,000 person-years. Researchers found stable annual incidence among the population with type 1 diabetes.
“Although our data are reported in terms of incidence among people with diabetes, the total burden of diabetes-related ESKD is also related to the numbers of people with diabetes,” the authors wrote. “The numbers of people with T2DM (type 2 diabetes mellitus) increased markedly during the study period due to a combination of decreasing mortality and increasing incidence of diabetes.”
They found that among nonindigenous people with type 2 diabetes, incidence of ESKD increased at an annual rate of 2.2% (95% CI, 0.4-4.1). The greatest annual increase was observed among those younger than 50 years and those older than 80 years. Additionally, there was no observed increase over time in ESKD incidence among indigenous populations, although the incident rate ratio vs. nonindigenous populations was 4.03 (95% CI, 3.68-4.41).
“[The] increasing prevalence of diabetes coupled with the increasing risk for ESKD in T2DM suggest that the future demand for RRT will increase in Australia, which has major implications for our health system,” the authors wrote.
In a related editorial, Peter Rossing, MD, DMSc, Marie Frimodt-Møller, MD, PhD, and Frederik Persson, MD, DMSc, all from the Steno Diabetes Center Copenhagen, Gentofte, discussed how these results could impact ESKD and diabetes treatment in Australia.
“The authors mention that since 2011, blood pressure targets were increased from 130/80 to 140/90 mm Hg in guidelines for the treatment of diabetes, and they express concern that this may have led to less-intensive treatment of risk factors and thus contributed to insufficient management,” the editorial authors wrote. “Because clinical variables are not presented, the potential impact of this remains an important speculation.
“We acknowledge the special challenges with the indigenous population and those living in remote areas of Australia, given their high risk for ESKD,” they added. “There is an urgent need to better understand their disease process, as well as focus on tools addressing the special needs of this population. However, ESKD in other populations is what is driving the overall trends in Australia.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
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