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Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991–2005)

¹ Australia and New Zealand Dialysis and Transplant Registry, Woodville, South Australia, Australia
² Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Benite, France
³ Department of Nephrology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and University of Adelaide, Adelaide, South Australia, Australia

Address correspondence and reprint requests to Emmanuel Villar, MD, PhD, ANZDATA Registry, The Queen Elizabeth Hospital, 28 Woodville Rd., Woodville South, South Australia 5011, Australia. E-mail: emmanuel.villar{at}anzdata.org.au

OBJECTIVE—We aimed to update the epidemiology of type 1 and type 2 diabetic patients among the incident end-stage renal disease (ESRD) population in Australia and New Zealand (ANZ) and to determine whether outcome is worse for diabetic women, as described in the general population.

RESEARCH DESIGNS AND METHODS—All resident adults of ANZ who began renal replacement therapy (RRT) from 1 April 1991 to 31 December 2005 were included using data from the ANZ Dialysis and Transplant Registry. Incidence rates, RRT, and survival were analyzed. Risk factors for death were assessed using Cox regression.

RESULTS—The study included 1,284 type 1 diabetic (4.5%), 8,560 type 2 diabetic (30.0%), and 18,704 nondiabetic (65.5%) patients. The incidence rate of ESRD with type 2 diabetes increased markedly over time (+10.2% annually, P < 0.0001). In patients aged <70 years, rates of renal transplantation in type 1 diabetic, type 2 diabetic, and nondiabetic patients were 41.8, 6.5 (P < 0.0001 vs. other patients), and 40.9% (P = 0.56 vs. type 1 diabetic patients), respectively. Compared with nondiabetic patients, the adjusted hazard ratio (HR) for death was 1.64 (P < 0.0001) in type 1 diabetes and 1.13 (P < 0.0001) in type 2 diabetes. Survival rates per 5-year period improved by 6% in type 1 diabetic patients (P = 0.36), by 9% in type 2 diabetic patients (P < 0.0001), and by 5% in nondiabetic patients (P = 0.001). In type 2 diabetic patients aged 60 years, the adjusted HR for death in women versus men was 1.19 (P = 0.0003).

CONCLUSIONS—The incidence of ESRD with type 2 diabetes increased markedly. Despite high access to renal transplants, type 1 diabetic patients had a poor prognosis after starting RRT. Survival improved significantly in type 2 diabetic patients during the study period. Older type 2 diabetic women had a worse prognosis than older type 2 diabetic men.

Abbreviations: ANZ, Australia and New Zealand • ANZDATA, Australia and New Zealand Dialysis and Transplant Registry • eGFR, estimated glomerular filtration rate • ESRD, end-stage renal disease • RRT, renal replacement therapy • RTx, renal transplantation

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				E. Villar and M. Labeeuw Relative mortality risk in chronic kidney disease and end-stage renal disease: the effect of age, sex and diabetes Nephrol. Dial. Transplant., May 1, 2008; 23(5): 1770 - 1771. [Full Text] [PDF]

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