Cumulative Risk of End-Stage Renal Disease Among Patients With Type 2 Diabetes: A Nationwide Inception Cohort Study.

Patrik Finne, Per-Henrik Groop, Martti Arffman, Marjo Kervinen, Jaakko Helve, Carola Grönhagen-Riska, Reijo Sund

REVIEW


04 April 2019

Interesting study but not much clinical applicability. The incidence of ESRD seems very low to me but this could reflect differences in the Finnish population.


RELEVANCE 1
INNOVATIVENESS 3
APPLICABILITY 1
OVERALL 2

PAPER DETAILS


TITLE

Cumulative Risk of End-Stage Renal Disease Among Patients With Type 2 Diabetes: A Nationwide Inception Cohort Study.

ABSTRACT

OBJECTIVE
To estimate long-term cumulative risk of end-stage renal disease (ESRD) after diagnosis of type 2 diabetes.

RESEARCH DESIGN AND METHODS
This nationwide population-based inception cohort study included 421,429 patients with type 2 diabetes diagnosed in 1990-2011; patients were followed until the end of 2013. Data linkage between several national health care registers in Finland, covering 100% of the population, enabled the inclusion of almost all inhabitants who started taking diabetes medication or were hospitalized for diabetes. Cumulative risk of ESRD and hazard ratios [HR] for ESRD and death were estimated according to age, sex, and time period of diabetes diagnosis.

RESULTS
Among 421,429 patients with type 2 diabetes, 1,516 developed ESRD and 150,524 died during 3,458,797 patient-years of follow-up. Cumulative risk of ESRD was 0.29% at 10 years and 0.74% at 20 years from diagnosis of diabetes. Risk was higher among men than among women (HR 1.93 [95% CI 1.72-2.16]), decreased with older age at diagnosis (HR 0.70 [95% CI 0.60-0.81] for age 60-69 vs. 40-49 years), and was lower for those diagnosed in 2000-2011 than in 1990-1994 (HR 0.72 [95% CI 0.63-0.81]). Patients diagnosed with diabetes in 2000-2011 had lower risk of death during follow-up than those diagnosed in 1990-1994 (HR 0.64 [95% CI 0.63-0.65]).

CONCLUSIONS
Cumulative risk of ESRD is minimal among patients with type 2 diabetes compared with their risk of death. Patients diagnosed with diabetes at an older age have a lower risk of ESRD due to higher competing mortality.



AUTHOR(S)

Patrik Finne, Per-Henrik Groop, Martti Arffman, Marjo Kervinen, Jaakko Helve, Carola Grönhagen-Riska, Reijo Sund,

JOURNAL

Diabetes care

PLACE

United States