End-stage renal disease risk for adults with type 2 diabetes may be lower than assumed, with the competing risk for death among older adults a primary reason, according to findings published in Diabetes Care.
“Our study shows that risk of ESRD is small among people with type 2 diabetes. This may seem unexpected because a substantial proportion of patients are entering early stages of chronic kidney disease, with 25% of patients having microalbuminuria and 5% having macroalbuminuria 10 years after their diabetes diagnosis,” Patrik Finne, MD, PhD, of the Abdominal Centre Nephrology at the University of Helsinki and Helsinki University Hospital in Finland, and colleagues wrote. “These early stages of kidney disease are associated with increased premature mortality; this contributes to the fact that relatively few patients develop ESRD, as death is a common competing risk event.”
Finne and colleagues conducted a nationwide population-based inception cohort study with 421,429 adults aged at least 40 years with type 2 diabetes as confirmed through the Diabetes in Finland database (49.4% women). The researchers confirmed ESRD through the Finnish Registry for Kidney Diseases and deaths through the Causes of Death Register of Statistics Finland. All participants were diagnosed with type 2 diabetes between 1990 and 2011 and followed until ESRD diagnosis, death or Dec. 31, 2013, when the study concluded.
During a median follow-up of 6.82 years, 1,516 participants were diagnosed with ESRD while 150,524 died. The researchers found that the cumulative risk for ESRD 10 years after type 2 diabetes diagnosis was 0.29%. The cumulative risk rose to 0.74% at the 20-year mark following diagnosis. In addition, men were at a higher risk for developing ESRD compared with women (HR = 1.93; 95% CI, 1.72-2.16).
Risk for developing ESRD shrank as age increased, with participants aged 50 to 59 years (HR = 0.82; 95% CI, 0.71-0.94) and 60 to 69 years (HR = 0.7; 95% CI, 0.6-0.81) at higher risk than participants aged 70 to 79 years (HR = 0.45; 95% CI, 0.37-0.54) and those aged at least 80 years (HR = 0.09; 95% CI, 0.05-0.14). Conversely, risk for death increased with age, with participants aged at least 80 years at higher risk (HR = 22.8; 95% CI, 22.2-23.4) than those aged 70 to 79 years (HR = 8.3; 95% CI, 8-8.5), those aged 60 to 69 years (HR = 3.2; 95% CI, 3.2-3.3) and those aged 50 to 59 years (HR = 1.6; 95% CI, 1.5-1.6).
The researchers found that being diagnosed more recently lowered risk for ESRD. Those diagnosed between 2000 and 2011 were at the lowest risk (HR = 0.72; 95% CI, 0.63-0.81) compared with those diagnosed between 1995 and 1999 (HR = 0.77; 95% CI, 0.67-0.88) and those diagnosed between 1990 and 1994, who were used as reference.
“Our findings are important for clinicians who inform patients with type 2 diabetes about the associated risks and complications. As type 2 diabetes is a common disease, our study also has implications for policymakers,” the researchers wrote. “Notably, people diagnosed with type 2 diabetes at an older age have a lower risk of ESRD and a higher risk of death than those diagnosed at a younger age.” – by Phil Neuffer
Disclosures: Finne reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.