Abstract

Objective: We aim to update the epidemiology of type 1 (T1DM) and type 2 diabetes (T2DM) patients among the incident end-stage renal disease (ESRD) population in Australia and New Zealand (ANZ), and to determine if 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 01/04/1991 to 31/12/2005 were included using data from the ANZDATA Registry. Incidence rates, RRT, and survival were analysed. Risk factors for death were assessed using Cox regression.

Results: The study included 1284 T1DM (4.5%), 8560 T2DM (30.0%), and 18704 non-diabetic (noDM) (65.5%) patients. Incidence rate of ESRD with T2DM increased markedly over time (+10.2% annually, p<0.0001). In patients <70 years, rates of renal transplantation in T1DM, T2DM, and noDM patients were 41.8%, 6.5% (p<0.0001 vs. other patients), and 40.9% (p=0.56 vs. T1DM patients) respectively. Compared with noDM, adjusted hazard ratio (HR) for death was 1.64 (p<0.0001) in T1DM, and 1.13 (p<0.0001) in T2DM. Survival rates per five-year periods improved by 6% in T1DM (p=0.36), by 9% in T2DM (p<0.0001), and by 5% in noDM (p=0.001). In ≥60 year-old T2DM patients, adjusted HR for death in women versus men was 1.19 (p=0.0003).

Conclusions: Incidence of ESRD with T2DM increased markedly. Despite high access to renal transplant, T1DM patients had a poor prognosis after starting RRT. Survival improved significantly in T2DM patients during study period. Elderly T2DM women had a worse prognosis compared to elderly T2DM men.