End stage renal disease and survival in people with diabetes: a national database linkage study

S. Bell (Lead / Corresponding author), E. H. Fletcher, I. Brady, H. C. Looker, D. Levin, N. Joss, J. P. Traynor, W. Metcalfe, B. Conway, S. Livingstone, G. Leese, S. Philip, S. Wild, N. Halbesma, N. Sattar, R. S. Lindsay, J. McKnight, D. Pearson, H. M. Colhoun, Scottish Diabetes Research NetworkThe Scottish Renal Registry (SRR)

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    Background: Increasing prevalence of diabetes worldwide is projected to lead to an increase in patients with end stage renal disease (ESRD) requiring renal replacement therapy (RRT).

    Aim: To provide contemporary estimates of the prevalence of ESRD and requirement for RRT among people with diabetes in a nationwide study and to report associated survival.

    Methods: Data were extracted and linked from three national databases: Scottish Renal Registry, Scottish Care Initiative-Diabetes Collaboration and National Records of Scotland death data. Survival analyses were modelled with Cox regression.

    Results: Point prevalence of Chronic Kidney Disease (CKD)5 in 2008 was 1.63% of 19,414 people with type 1 diabetes (T1DM) compared to 0.58% of 167,871 people with type 2 diabetes (T2DM) (Odds ratio for DM type 0.97, p=0.77, on adjustment for duration Whilst 83% of those with T1DM and CKD5 and 61% of those with T2DM and CKD5 were receiving RRT, there was no difference when adjusted for age, sex and DM duration (Odds ratio for DM type 0.83, p=0.432). Diabetic nephropathy was the Primary Renal Diagnosis (PRD) in 91% of people with T1DM and 58% of people with T2DM on RRT. Median survival time from initiation of RRT was 3.84 years (95% CI 2.77, 4.62) in T1DM and 2.16 years (95% CI 1.92, 2.38) in T2DM.

    Conclusion: Considerable numbers of patients with diabetes continue to progress to CKD5 and RRT. Almost half of all RRT cases in T2DM are considered to be due to conditions other than diabetic nephropathy. Median survival time for people with diabetes from initiation of RRT remains poor. These prevalence data are important for future resource planning.
    Original languageEnglish
    Pages (from-to)127-134
    Number of pages8
    JournalQJM : an International Journal of Medicine
    Issue number2
    Early online date19 Aug 2014
    Publication statusPublished - Feb 2015


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