End-stage renal disease and survival in people with diabetes

a national database linkage study

S Bell, E H Fletcher, I Brady, H C Looker, D Levin, N Joss, J P Traynor, W Metcalfe, B Conway, S Livingstone, G Leese, S Philip, S Wild, N Halbesma, N Sattar, R S Lindsay, J McKnight, D Pearson, H M Colhoun, Scottish Diabetes Research Network and Scottish Renal Registry

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Abstract

BACKGROUND: Increasing prevalence of diabetes worldwide is projected to lead to an increase in patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT).

AIM: To provide contemporary estimates of the prevalence of ESRD and requirement for RRT among people with diabetes in a nationwide study and to report associated survival.

METHODS: Data were extracted and linked from three national databases: Scottish Renal Registry, Scottish Care Initiative-Diabetes Collaboration and National Records of Scotland death data. Survival analyses were modelled with Cox regression.

RESULTS: Point prevalence of chronic kidney disease (CKD)5 in 2008 was 1.63% of 19 414 people with type 1 diabetes (T1DM) compared with 0.58% of 167 871 people with type 2 diabetes (T2DM) (odds ratio for DM type 0.97, P = 0.77, on adjustment for duration. Although 83% of those with T1DM and CKD5 and 61% of those with T2DM and CKD5 were receiving RRT, there was no difference when adjusted for age, sex and DM duration (odds ratio for DM type 0.83, P = 0.432). Diabetic nephropathy was the primary renal diagnosis in 91% of people with T1DM and 58% of people with T2DM on RRT. Median survival time from initiation of RRT was 3.84 years (95% CI 2.77, 4.62) in T1DM and 2.16 years (95% CI: 1.92, 2.38) in T2DM.

CONCLUSION: Considerable numbers of patients with diabetes continue to progress to CKD5 and RRT. Almost half of all RRT cases in T2DM are considered to be due to conditions other than diabetic nephropathy. Median survival time for people with diabetes from initiation of RRT remains poor. These prevalence data are important for future resource planning.

Original languageEnglish
Pages (from-to)127-134
Number of pages8
JournalQJM
Volume108
Issue number2
Early online date19 Aug 2014
DOIs
Publication statusPublished - 1 Feb 2015

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Renal Replacement Therapy
Chronic Kidney Failure
Databases
Survival
Diabetic Nephropathies
Odds Ratio
Kidney
Death Certificates
Scotland
Survival Analysis
Type 1 Diabetes Mellitus
Chronic Renal Insufficiency
Type 2 Diabetes Mellitus
Registries

Cite this

Bell, S., Fletcher, E. H., Brady, I., Looker, H. C., Levin, D., Joss, N., ... Scottish Diabetes Research Network and Scottish Renal Registry (2015). End-stage renal disease and survival in people with diabetes: a national database linkage study. QJM, 108(2), 127-134. https://doi.org/10.1093/qjmed/hcu170

End-stage renal disease and survival in people with diabetes : a national database linkage study. / Bell, S; Fletcher, E H; Brady, I; Looker, H C; Levin, D; Joss, N; Traynor, J P; Metcalfe, W; Conway, B; Livingstone, S; Leese, G; Philip, S; Wild, S; Halbesma, N; Sattar, N; Lindsay, R S; McKnight, J; Pearson, D; Colhoun, H M; Scottish Diabetes Research Network and Scottish Renal Registry.

In: QJM, Vol. 108, No. 2, 01.02.2015, p. 127-134.

Research output: Contribution to journalArticle

Bell, S, Fletcher, EH, Brady, I, Looker, HC, Levin, D, Joss, N, Traynor, JP, Metcalfe, W, Conway, B, Livingstone, S, Leese, G, Philip, S, Wild, S, Halbesma, N, Sattar, N, Lindsay, RS, McKnight, J, Pearson, D, Colhoun, HM & Scottish Diabetes Research Network and Scottish Renal Registry 2015, 'End-stage renal disease and survival in people with diabetes: a national database linkage study', QJM, vol. 108, no. 2, pp. 127-134. https://doi.org/10.1093/qjmed/hcu170
Bell S, Fletcher EH, Brady I, Looker HC, Levin D, Joss N et al. End-stage renal disease and survival in people with diabetes: a national database linkage study. QJM. 2015 Feb 1;108(2):127-134. https://doi.org/10.1093/qjmed/hcu170
Bell, S ; Fletcher, E H ; Brady, I ; Looker, H C ; Levin, D ; Joss, N ; Traynor, J P ; Metcalfe, W ; Conway, B ; Livingstone, S ; Leese, G ; Philip, S ; Wild, S ; Halbesma, N ; Sattar, N ; Lindsay, R S ; McKnight, J ; Pearson, D ; Colhoun, H M ; Scottish Diabetes Research Network and Scottish Renal Registry. / End-stage renal disease and survival in people with diabetes : a national database linkage study. In: QJM. 2015 ; Vol. 108, No. 2. pp. 127-134.
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abstract = "BACKGROUND: Increasing prevalence of diabetes worldwide is projected to lead to an increase in patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT).AIM: To provide contemporary estimates of the prevalence of ESRD and requirement for RRT among people with diabetes in a nationwide study and to report associated survival.METHODS: Data were extracted and linked from three national databases: Scottish Renal Registry, Scottish Care Initiative-Diabetes Collaboration and National Records of Scotland death data. Survival analyses were modelled with Cox regression.RESULTS: Point prevalence of chronic kidney disease (CKD)5 in 2008 was 1.63{\%} of 19 414 people with type 1 diabetes (T1DM) compared with 0.58{\%} of 167 871 people with type 2 diabetes (T2DM) (odds ratio for DM type 0.97, P = 0.77, on adjustment for duration. Although 83{\%} of those with T1DM and CKD5 and 61{\%} of those with T2DM and CKD5 were receiving RRT, there was no difference when adjusted for age, sex and DM duration (odds ratio for DM type 0.83, P = 0.432). Diabetic nephropathy was the primary renal diagnosis in 91{\%} of people with T1DM and 58{\%} of people with T2DM on RRT. Median survival time from initiation of RRT was 3.84 years (95{\%} CI 2.77, 4.62) in T1DM and 2.16 years (95{\%} CI: 1.92, 2.38) in T2DM.CONCLUSION: Considerable numbers of patients with diabetes continue to progress to CKD5 and RRT. Almost half of all RRT cases in T2DM are considered to be due to conditions other than diabetic nephropathy. Median survival time for people with diabetes from initiation of RRT remains poor. These prevalence data are important for future resource planning.",
author = "S Bell and Fletcher, {E H} and I Brady and Looker, {H C} and D Levin and N Joss and Traynor, {J P} and W Metcalfe and B Conway and S Livingstone and G Leese and S Philip and S Wild and N Halbesma and N Sattar and Lindsay, {R S} and J McKnight and D Pearson and Colhoun, {H M} and {Scottish Diabetes Research Network and Scottish Renal Registry}",
note = "{\circledC} The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. Funding This work was supported by the Wellcome Trust through the Scottish Health Informatics Programme (SHIP). The SHIP is collaboration between the Universities of Aberdeen, Dundee, Edinburgh, Glasgow and St Andrews and the Information Services Division of National Health Service National Service Scotland. Funding for diabetes register linkage and data extraction was provided by the Chief Scientist’s Office of the Scottish Government. The Scottish Diabetes Research Network receives financial support from National Health Services Research Scotland. The Scottish Renal Registry is funded by the Information Services Division of National Health Service National Services Scotland but relies heavily on the goodwill of the contributing renal units who spent a large amount time working with Scottish Renal Registry staff to ensure that the data held within the register are accurate and complete.",
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T1 - End-stage renal disease and survival in people with diabetes

T2 - a national database linkage study

AU - Bell, S

AU - Fletcher, E H

AU - Brady, I

AU - Looker, H C

AU - Levin, D

AU - Joss, N

AU - Traynor, J P

AU - Metcalfe, W

AU - Conway, B

AU - Livingstone, S

AU - Leese, G

AU - Philip, S

AU - Wild, S

AU - Halbesma, N

AU - Sattar, N

AU - Lindsay, R S

AU - McKnight, J

AU - Pearson, D

AU - Colhoun, H M

AU - Scottish Diabetes Research Network and Scottish Renal Registry

N1 - © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. Funding This work was supported by the Wellcome Trust through the Scottish Health Informatics Programme (SHIP). The SHIP is collaboration between the Universities of Aberdeen, Dundee, Edinburgh, Glasgow and St Andrews and the Information Services Division of National Health Service National Service Scotland. Funding for diabetes register linkage and data extraction was provided by the Chief Scientist’s Office of the Scottish Government. The Scottish Diabetes Research Network receives financial support from National Health Services Research Scotland. The Scottish Renal Registry is funded by the Information Services Division of National Health Service National Services Scotland but relies heavily on the goodwill of the contributing renal units who spent a large amount time working with Scottish Renal Registry staff to ensure that the data held within the register are accurate and complete.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BACKGROUND: Increasing prevalence of diabetes worldwide is projected to lead to an increase in patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT).AIM: To provide contemporary estimates of the prevalence of ESRD and requirement for RRT among people with diabetes in a nationwide study and to report associated survival.METHODS: Data were extracted and linked from three national databases: Scottish Renal Registry, Scottish Care Initiative-Diabetes Collaboration and National Records of Scotland death data. Survival analyses were modelled with Cox regression.RESULTS: Point prevalence of chronic kidney disease (CKD)5 in 2008 was 1.63% of 19 414 people with type 1 diabetes (T1DM) compared with 0.58% of 167 871 people with type 2 diabetes (T2DM) (odds ratio for DM type 0.97, P = 0.77, on adjustment for duration. Although 83% of those with T1DM and CKD5 and 61% of those with T2DM and CKD5 were receiving RRT, there was no difference when adjusted for age, sex and DM duration (odds ratio for DM type 0.83, P = 0.432). Diabetic nephropathy was the primary renal diagnosis in 91% of people with T1DM and 58% of people with T2DM on RRT. Median survival time from initiation of RRT was 3.84 years (95% CI 2.77, 4.62) in T1DM and 2.16 years (95% CI: 1.92, 2.38) in T2DM.CONCLUSION: Considerable numbers of patients with diabetes continue to progress to CKD5 and RRT. Almost half of all RRT cases in T2DM are considered to be due to conditions other than diabetic nephropathy. Median survival time for people with diabetes from initiation of RRT remains poor. These prevalence data are important for future resource planning.

AB - BACKGROUND: Increasing prevalence of diabetes worldwide is projected to lead to an increase in patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT).AIM: To provide contemporary estimates of the prevalence of ESRD and requirement for RRT among people with diabetes in a nationwide study and to report associated survival.METHODS: Data were extracted and linked from three national databases: Scottish Renal Registry, Scottish Care Initiative-Diabetes Collaboration and National Records of Scotland death data. Survival analyses were modelled with Cox regression.RESULTS: Point prevalence of chronic kidney disease (CKD)5 in 2008 was 1.63% of 19 414 people with type 1 diabetes (T1DM) compared with 0.58% of 167 871 people with type 2 diabetes (T2DM) (odds ratio for DM type 0.97, P = 0.77, on adjustment for duration. Although 83% of those with T1DM and CKD5 and 61% of those with T2DM and CKD5 were receiving RRT, there was no difference when adjusted for age, sex and DM duration (odds ratio for DM type 0.83, P = 0.432). Diabetic nephropathy was the primary renal diagnosis in 91% of people with T1DM and 58% of people with T2DM on RRT. Median survival time from initiation of RRT was 3.84 years (95% CI 2.77, 4.62) in T1DM and 2.16 years (95% CI: 1.92, 2.38) in T2DM.CONCLUSION: Considerable numbers of patients with diabetes continue to progress to CKD5 and RRT. Almost half of all RRT cases in T2DM are considered to be due to conditions other than diabetic nephropathy. Median survival time for people with diabetes from initiation of RRT remains poor. These prevalence data are important for future resource planning.

U2 - 10.1093/qjmed/hcu170

DO - 10.1093/qjmed/hcu170

M3 - Article

VL - 108

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JO - QJM

JF - QJM

SN - 1460-2725

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