Survival of Patients With Type 1 Diabetes Receiving Renal Replacement Therapy in 1980–2007
- Mikko Haapio, MD1,
- Jaakko Helve, MD2,
- Per-Henrik Groop, MD, PHD1,
- Carola Grönhagen-Riska, MD, PHD2 and
- Patrik Finne, MD, PHD3,4
- 1Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland;
- 2Helsinki University Central Hospital, Department of Medicine, Helsinki, Finland;
- 3Finnish Registry for Kidney Diseases, Helsinki, Finland;
- 4School of Public Health, University of Tampere, Tampere, Finland.
- Corresponding author: Mikko Haapio, .
OBJECTIVE Risks of end-stage renal disease and premature death in patients with type 1 diabetes have declined over the past decades. Data on the survival of patients receiving renal replacement therapy (RRT) are, however, limited. We investigated whether survival of patients with type 1 diabetes receiving RRT has improved over time and whether improvement can be attributable to progress in dialysis treatment or diabetes care.
RESEARCH DESIGN AND METHODS An incident cohort of all patients with type 1 diabetes (n = 1,604) starting chronic RRT in Finland between 1980 and 2005 were followed until death or end of follow-up on 31 December 2007. The control group (n = 1,556) consisted of patients with glomerulonephritis who started RRT. All patients were identified from the Finnish Registry for Kidney Diseases.
RESULTS Median survival time of patients with type 1 diabetes increased progressively from 3.60 years during 1980–1984 to >8 years in 2000–2005. In 2000–2005, the unadjusted relative risk of death was 0.55 compared with 1980–1984. After adjustment for the most important variables, the corresponding relative risk of death was only 0.23. For patients with glomerulonephritis, the adjusted relative risk decreased to a lesser extent to 0.30 (P = 0.007).
CONCLUSIONS Survival of patients with type 1 diabetes and end-stage renal disease has improved since the 1980s despite a conspicuous increase in the age of patients who start RRT, suggesting not only true progress in dialysis therapy and overall treatment of patients with end-stage renal disease but possibly also improved management of diabetes.
The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
- © 2010 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.