New research suggests that the number of type 1 diabetics with the most advanced form of kidney disease -- end-stage renal disease or ESRD -- may be lower than previously estimated. The research also suggests that the outlook with regard to ESRD in diabetic patients has improved over the years.
In ESRD, the kidneys lose their ability to filter waste products from the blood and excrete them in the urine. People with ESRD need kidney dialysis or a kidney transplant to stay alive.
ESRD is one of the most severe complications of type 1 diabetes and diabetes is the most important cause of ESRD. “Yet, data on patients’ risk of developing ESRD are sparse,” Dr. Patrik Finne from the University of Helsinki and colleagues note in the Journal of the American Medical Association this week.
To investigate, they used the Finnish Diabetes Register to identify all 20,005 patients younger than 30 years of age diagnosed with diabetes in Finland between 1965 and 1999.
During follow-up lasting a maximum of 37 years and a median of 17 years, 632 patients developed ESRD and 1,417 died.
The investigators report that the cumulative incidence of ESRD was 2.2 percent 20 years after diagnosis and 7.8 percent 30 years after diagnosis, which is lower than previously published estimates.
The risk of ESRD did not differ markedly by gender, was lower for those diagnosed with diabetes in “more recent years” and was lowest (3.3 percent at 30 years) in children diagnosed with type 1 diabetes before 5 years of age.
“Children who get diabetes before the age of 5 years appear to be initially protected against ESRD,” Finne noted in comments to Reuters Health. “But this difference disappears when they get older. When these patients were 33 years old, about 5 percent had ESRD regardless of age at diagnosis of diabetes.”
Summing up, Finne said their work suggests that “the risk of developing ESRD has dropped by more than half since 1965-1969,” probably due to advances in diabetes therapies.
“For example, for more than 20 years patients have been able to measure blood glucose at home and adjust the insulin dose accordingly,” he explained. The insulin treatment has also developed, with the introduction of rapid-acting insulin. In addition, new drugs to lower high blood pressure have been developed and high blood pressure, a risk factor for ESRD, is more effectively treated nowadays.
Nonetheless, Finne and colleagues say, type 1 diabetic patients with ESRD are at significantly increased risk of dying compared to type 1 diabetic patients without ESRD - a finding that highlights the severity of ESRD as a complication of diabetes.