Issue 168 Item 15 Incidence of End-Stage Renal Disease in Type 1 Diabetics Decli

Better glycemic control and blood pressure treatments having an effect.

In patients with type 1 diabetes, the rate at which end-stage renal disease occurs has been improving.

An international team led by Dr. Rimei Nishimura of the Jikei University School of Medicine in Tokyo, Japan, analyzed the incidence of end-stage renal disease and related mortality in 975 patients in Pennsylvania who had developed type 1 diabetes at least 19 years earlier.

When the study was performed, 104 of the patients had developed end-stage renal disease. Twenty-nine patients received dialysis, 44 received dialysis followed by renal transplantation, 26 had successful transplants without having been on dialysis, and 5 patients had to resume dialysis after unsuccessful kidney transplants.

The authors found that 20-year cumulative incidence rates of end stage renal disease had declined over time. Specifically, they said, this rate was 9.1% for patients diagnosed with diabetes between 1965 and 1969, 4.7% for patients diagnosed between 1970 and 1974, and 3.6% for those diagnosed between 1975 and 1979.

Five-year cumulative survival rates after the introduction of renal replacement therapy — either dialysis or transplantation — also rose over time. For patients diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979, these rates were 58.8%, 73.5% and 87.5%, respectively. However, this increase was not statistically significant, "probably because of the small number of events," the authors said.

"The incidence of end stage renal disease…in this cohort…declined, reflecting in all probability the better glycemic control and blood pressure treatment available since the early 1980s," the investigators conclude. Am J Kidney Dis 2003; 42:117-124.