BACKGROUND: Little information is available regarding the long-term incidence of end-stage renal disease (ESRD) and survival after the introduction of renal replacement therapy (RRT) in patients with type 1 diabetes. METHODS: We studied 1,075 patients with type 1 diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who comprise the Allegheny County population-based registry. Onset of ESRD was defined as the introduction of RRT (dialysis or transplantation). RESULTS: Of 1,075 registrants, the living status of 975 patients (90.7%) and complication status of 798 patients (74.2%) were ascertained as of January 1, 1999. During the observation period, 104 patients (13.0%) developed ESRD, for an incidence rate of 521/100,000 person-years (95% confidence interval, 424 to 629). The cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant decline was observed in 20-year cumulative incidence rates of ESRD for patients diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%, and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients (28%) received dialysis alone, 44 patients (42%) received dialysis followed by kidney transplantation, 26 patients (25%) underwent successful transplantation alone, and 5 patients (5%) underwent a failed kidney transplantation followed by dialysis therapy. The cumulative survival rate 10 years after the introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy followed by kidney transplantation was significantly greater than that of dialysis therapy alone (P < 0.001). No difference was detected in survival between pancreas-kidney transplant recipients and kidney-alone transplant recipients (P = 0.7). CONCLUSION: The incidence of ESRD observed in this cohort has declined, probably reflecting the better glycemic and blood pressure control available since the early 1980s.
BACKGROUND: Little information is available regarding the long-term incidence of end-stage renal disease (ESRD) and survival after the introduction of renal replacement therapy (RRT) in patients with type 1 diabetes. METHODS: We studied 1,075 patients with type 1 diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who comprise the Allegheny County population-based registry. Onset of ESRD was defined as the introduction of RRT (dialysis or transplantation). RESULTS: Of 1,075 registrants, the living status of 975 patients (90.7%) and complication status of 798 patients (74.2%) were ascertained as of January 1, 1999. During the observation period, 104 patients (13.0%) developed ESRD, for an incidence rate of 521/100,000 person-years (95% confidence interval, 424 to 629). The cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant decline was observed in 20-year cumulative incidence rates of ESRD for patients diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%, and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients (28%) received dialysis alone, 44 patients (42%) received dialysis followed by kidney transplantation, 26 patients (25%) underwent successful transplantation alone, and 5 patients (5%) underwent a failed kidney transplantation followed by dialysis therapy. The cumulative survival rate 10 years after the introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy followed by kidney transplantation was significantly greater than that of dialysis therapy alone (P < 0.001). No difference was detected in survival between pancreas-kidney transplant recipients and kidney-alone transplant recipients (P = 0.7). CONCLUSION: The incidence of ESRD observed in this cohort has declined, probably reflecting the better glycemic and blood pressure control available since the early 1980s.
Authors: Jan Skupien; James H Warram; Adam M Smiles; Robert C Stanton; Andrzej S Krolewski Journal: Diabetes Care Date: 2016-09-19 Impact factor: 19.112
Authors: S Bell; 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 Journal: QJM Date: 2014-08-19
Authors: Marcus G Pezzolesi; G David Poznik; Josyf C Mychaleckyj; Andrew D Paterson; Michelle T Barati; Jon B Klein; Daniel P K Ng; Grzegorz Placha; Luis H Canani; Jacek Bochenski; Daryl Waggott; Michael L Merchant; Bozena Krolewski; Lucia Mirea; Krzysztof Wanic; Pisut Katavetin; Masahiko Kure; Pawel Wolkow; Jonathon S Dunn; Adam Smiles; William H Walker; Andrew P Boright; Shelley B Bull; Alessandro Doria; John J Rogus; Stephen S Rich; James H Warram; Andrzej S Krolewski Journal: Diabetes Date: 2009-02-27 Impact factor: 9.461
Authors: Tien Y Wong; Mkaya Mwamburi; Ronald Klein; Michael Larsen; Harry Flynn; Marisol Hernandez-Medina; Gayatri Ranganathan; Barbara Wirostko; Andreas Pleil; Paul Mitchell Journal: Diabetes Care Date: 2009-12 Impact factor: 17.152
Authors: Christina Bächle; Andrea Icks; Klaus Straßburger; Marion Flechtner-Mors; Andreas Hungele; Peter Beyer; Kerstin Placzek; Ulrich Hermann; Andrea Schumacher; Markus Freff; Anna Stahl-Pehe; Reinhard W Holl; Joachim Rosenbauer Journal: PLoS One Date: 2013-08-13 Impact factor: 3.240