Abstract

Objective - Risks of end-stage renal disease and premature death in patients with type 1 diabetes have declined over the past decades. Data on their survival on renal replacement therapy (RRT) are, however, limited. We investigated whether survival of patients with type 1 diabetes on RRT has improved over time and, if 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 = 1604) entering chronic RRT in Finland between 1980 and 2005 were followed until death or end of follow-up on 31 December 2007. Control group (n = 1556) consisted of glomerulonephritis patients that entered 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 more than 8 years in 2000-2005. In 2000-2005 the unadjusted relative risk of death was 0.55 compared to 1980-1984. After adjustment for most important variables the corresponding relative risk of death was only 0.23. For glomerulonephritis patients 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 age of patients that enter RRT, suggesting true progress not only in dialysis therapy and overall treatment of patients with end-stage renal disease, but possibly also improved management of diabetes.