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Cumulative Risk of End-Stage Renal Disease Among Patients With Type 2 Diabetes: A Nationwide Inception Cohort Study
Patrik Finne1,2, Per-Henrik Groop3,4,5, Martti Arffman6
1Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland patrik.finne@hus.fi.
Diabetes Care
|January 30, 2019
Summary
The long-term risk of end-stage renal disease (ESRD) for type 2 diabetes patients is low, especially compared to their risk of death. Older age at diagnosis is linked to lower ESRD risk due to higher competing mortality.
Area of Science:
- Nephrology
- Endocrinology
- Public Health
Background:
- Type 2 diabetes is a global health concern with significant long-term complications.
- End-stage renal disease (ESRD) is a severe complication of diabetes, impacting patient morbidity and mortality.
- Estimating the cumulative risk of ESRD is crucial for proactive patient management and resource allocation.
Purpose of the Study:
- To estimate the long-term cumulative risk of end-stage renal disease (ESRD) in patients diagnosed with type 2 diabetes.
- To analyze how factors like age, sex, and diagnosis time period influence ESRD risk.
- To compare the risk of ESRD with the risk of death in this patient cohort.
Main Methods:
- A nationwide, population-based inception cohort study was conducted in Finland.
- Included 421,429 patients diagnosed with type 2 diabetes between 1990 and 2011.
- Data linkage from national health registers provided comprehensive follow-up data until 2013.
Main Results:
- The cumulative risk of ESRD was 0.29% at 10 years and 0.74% at 20 years post-diagnosis.
- Men had a higher risk of ESRD than women (HR 1.93).
- Older age at diagnosis (60-69 years vs. 40-49 years) and a later diagnosis period (2000-2011 vs. 1990-1994) were associated with lower ESRD risk.
Conclusions:
- The cumulative risk of ESRD in type 2 diabetes patients is minimal compared to their overall mortality risk.
- Higher competing mortality in older patients at diagnosis contributes to a lower observed ESRD risk.
- Improved management or patient characteristics in recent years may explain the reduced ESRD risk for those diagnosed later.
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