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Survival of patients with type 1 diabetes receiving renal replacement therapy in 1980-2007.

Haapio M, Helve J, Groop PH, Grönhagen-Riska C, Finne P - Diabetes Care (2010)

Bottom Line: In 2000-2005, the unadjusted relative risk of death was 0.55 compared with 1980-1984.After adjustment for the most important variables, the corresponding relative risk of death was only 0.23.For patients with glomerulonephritis, the adjusted relative risk decreased to a lesser extent to 0.30 (P = 0.007).

View Article: PubMed Central - PubMed

Affiliation: Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland. mikko.haapio@hus.fi

ABSTRACT

Objective: Risks of end-stage renal disease and premature death in patients with type 1 diabetes have declined over the past decades. Data on the survival of patients receiving renal replacement therapy (RRT) are, however, limited. We investigated whether survival of patients with type 1 diabetes receiving RRT has improved over time and whether improvement can be attributable to progress in dialysis treatment or diabetes care.

Research design and methods: An incident cohort of all patients with type 1 diabetes (n = 1,604) starting chronic RRT in Finland between 1980 and 2005 were followed until death or end of follow-up on 31 December 2007. The control group (n = 1,556) consisted of patients with glomerulonephritis who started RRT. All patients were identified from the Finnish Registry for Kidney Diseases.

Results: Median survival time of patients with type 1 diabetes increased progressively from 3.60 years during 1980-1984 to >8 years in 2000-2005. In 2000-2005, the unadjusted relative risk of death was 0.55 compared with 1980-1984. After adjustment for the most important variables, the corresponding relative risk of death was only 0.23. For patients with glomerulonephritis, the adjusted relative risk decreased to a lesser extent to 0.30 (P = 0.007).

Conclusions: Survival of patients with type 1 diabetes and end-stage renal disease has improved since the 1980s despite a conspicuous increase in the age of patients who start RRT, suggesting not only true progress in dialysis therapy and overall treatment of patients with end-stage renal disease but possibly also improved management of diabetes.

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Survival probability of patients with type 1 diabetes beginning RRT according to start period of RRT and age at start of RRT. Survival probabilities were statistically significantly different between start year periods in all age-groups (P < 0.005).
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Figure 2: Survival probability of patients with type 1 diabetes beginning RRT according to start period of RRT and age at start of RRT. Survival probabilities were statistically significantly different between start year periods in all age-groups (P < 0.005).

Mentions: Of the 1,604 patients with type 1 diabetes, 1,047 (65.3%) had died, and 557 patients were censored (alive at the end of follow-up on 31 December 2007, n = 548; regained own kidney function, n = 5; moved abroad, n = 4; and lost to follow-up, n = 0). Cardiovascular causes remained the main cause of death and comprised 65.8% of deaths (Table 1). Median survival time increased throughout the span of our study, from 3.60 years (95% CI 2.50–4.70) to 7.24 (95% CI 5.74–8.74) from the time period 1980–1984 to 1995–1999 (Fig. 1). Median survival time of patients starting RRT during 2000–2005 could not be calculated because it was longer than the maximal follow-up time, thus indicating a median survival time of >8 years. The median survival times increased significantly in all of the age-groups (Fig. 2). The absolute risk of death within 5 years from the start of RRT dropped from 51% in 1980–1984 to 33% in 2000–2005. The unadjusted relative risk (RR) of death was 0.55 for patients that entered RRT in 2000–2005 compared with those that entered in 1980–1984 (Table 2). In the different age-groups the corresponding RRs were even lower, varying between 0.31 and 0.38, indicating a confounding effect of age. In univariate analysis, the risk of death increased by 4.1% (95% CI 3.4–4.7%) per year of age at the start of RRT. Sex was not associated with risk of death (P = 0.360). Patients having hemodialysis as the initial mode of RRT had 1.4-fold risk (95% CI 1.2–1.6) of death compared with patients that entered peritoneal dialysis. Death risk was much higher in patients who did not receive a kidney transplant within 2 years (RR 4.0 [95% CI 3.5–4.6]).


Survival of patients with type 1 diabetes receiving renal replacement therapy in 1980-2007.

Haapio M, Helve J, Groop PH, Grönhagen-Riska C, Finne P - Diabetes Care (2010)

Survival probability of patients with type 1 diabetes beginning RRT according to start period of RRT and age at start of RRT. Survival probabilities were statistically significantly different between start year periods in all age-groups (P < 0.005).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2909048&req=5

Figure 2: Survival probability of patients with type 1 diabetes beginning RRT according to start period of RRT and age at start of RRT. Survival probabilities were statistically significantly different between start year periods in all age-groups (P < 0.005).
Mentions: Of the 1,604 patients with type 1 diabetes, 1,047 (65.3%) had died, and 557 patients were censored (alive at the end of follow-up on 31 December 2007, n = 548; regained own kidney function, n = 5; moved abroad, n = 4; and lost to follow-up, n = 0). Cardiovascular causes remained the main cause of death and comprised 65.8% of deaths (Table 1). Median survival time increased throughout the span of our study, from 3.60 years (95% CI 2.50–4.70) to 7.24 (95% CI 5.74–8.74) from the time period 1980–1984 to 1995–1999 (Fig. 1). Median survival time of patients starting RRT during 2000–2005 could not be calculated because it was longer than the maximal follow-up time, thus indicating a median survival time of >8 years. The median survival times increased significantly in all of the age-groups (Fig. 2). The absolute risk of death within 5 years from the start of RRT dropped from 51% in 1980–1984 to 33% in 2000–2005. The unadjusted relative risk (RR) of death was 0.55 for patients that entered RRT in 2000–2005 compared with those that entered in 1980–1984 (Table 2). In the different age-groups the corresponding RRs were even lower, varying between 0.31 and 0.38, indicating a confounding effect of age. In univariate analysis, the risk of death increased by 4.1% (95% CI 3.4–4.7%) per year of age at the start of RRT. Sex was not associated with risk of death (P = 0.360). Patients having hemodialysis as the initial mode of RRT had 1.4-fold risk (95% CI 1.2–1.6) of death compared with patients that entered peritoneal dialysis. Death risk was much higher in patients who did not receive a kidney transplant within 2 years (RR 4.0 [95% CI 3.5–4.6]).

Bottom Line: In 2000-2005, the unadjusted relative risk of death was 0.55 compared with 1980-1984.After adjustment for the most important variables, the corresponding relative risk of death was only 0.23.For patients with glomerulonephritis, the adjusted relative risk decreased to a lesser extent to 0.30 (P = 0.007).

View Article: PubMed Central - PubMed

Affiliation: Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland. mikko.haapio@hus.fi

ABSTRACT

Objective: Risks of end-stage renal disease and premature death in patients with type 1 diabetes have declined over the past decades. Data on the survival of patients receiving renal replacement therapy (RRT) are, however, limited. We investigated whether survival of patients with type 1 diabetes receiving RRT has improved over time and whether improvement can be attributable to progress in dialysis treatment or diabetes care.

Research design and methods: An incident cohort of all patients with type 1 diabetes (n = 1,604) starting chronic RRT in Finland between 1980 and 2005 were followed until death or end of follow-up on 31 December 2007. The control group (n = 1,556) consisted of patients with glomerulonephritis who started RRT. All patients were identified from the Finnish Registry for Kidney Diseases.

Results: Median survival time of patients with type 1 diabetes increased progressively from 3.60 years during 1980-1984 to >8 years in 2000-2005. In 2000-2005, the unadjusted relative risk of death was 0.55 compared with 1980-1984. After adjustment for the most important variables, the corresponding relative risk of death was only 0.23. For patients with glomerulonephritis, the adjusted relative risk decreased to a lesser extent to 0.30 (P = 0.007).

Conclusions: Survival of patients with type 1 diabetes and end-stage renal disease has improved since the 1980s despite a conspicuous increase in the age of patients who start RRT, suggesting not only true progress in dialysis therapy and overall treatment of patients with end-stage renal disease but possibly also improved management of diabetes.

Show MeSH
Related in: MedlinePlus