Diabetic patients on renal replacement therapy: analysis of Catalan Registry data. Renal Registry Committee

In recent years, a progressive increase in the need of renal replacement therapy has been noted for patients with diabetes mellitus. The present report is based on an analysis of the data of the 'Registre de Malats Renals de Catalunya' (RMRC). It was the aim to identify (i) the incidence and prevalence of diabetic patients on renal replacement therapy, (ii) associated diseases, (iii) the relative risk of different modes of treatment, and (iv) the rate of death compared to non-diabetic patients on renal replacement therapy and in the general population.

Of the 936 diabetic patients starting renal replacement therapy during the period 1984-1994, 24.8% were classified as DN and IDDM, 65.7% as DN and NIDDM, and in 9.5%, diabetes accompanied renal failure from standard primary renal disease. The incidence of diabetic patients has increased from 3 per million population (pmp) in 1984 to 26.6 pmp in 1994. At any given age the risk of requiring renal replacement therapy with diabetes was 1.5-fold higher in males than in females. Of diabetic patients who were < 45 years of age, 55% received a renal transplant and > 50% lived with a simultaneous kidney/pancreas graft. For diabetic patients above this age, haemodialysis was the most prevalent form of treatment. Morbidity in diabetic patients was higher than in the overall RMRC population. Cardiac and vascular disease were the most prominent complications. Mortality of diabetic patients on renal replacement therapy was twice that of the overall population of RMRC and 16-fold higher than in the general population of Catalunya. The risk of death increased with age and was higher in patients with reduced functional autonomy. Transplanted patients had a smaller risk than patients on haemodialysis or CAPD. Survival has increased for patients starting treatment after 1990 compared to the period 1984-1989.

In conclusion, diabetes mellitus is one of the main causes leading to renal replacement therapy in Catalunya. Diabetic patients are more multimorbid than the rest of the population of the Registre de Malats Renals de Catalunya. These observations call for the institution of primary or secondary prevention.