End-stage renal disease attributable to diabetes mellitus.
OBJECTIVE
To determine the proportion of end-stage renal disease associated with diabetes mellitus in a biracial population, using population-attributable risk estimates.


METHODS
Case-control study.


METHODS
Population-based study in Maryland, Virginia, West Virginia, and Washington, D.C.


METHODS
716 newly treated patients with kidney failure aged 20 to 64 years and 361 age-matched controls.


METHODS
Self-reported history of diabetes mellitus, including type, duration, treatment, and complications.


RESULTS
Persons with insulin-dependent diabetes (odds ratio, 33.7) and non-insulin-dependent diabetes (odds ratio, 7.0) were at greater risk for end-stage renal disease than were persons without diabetes. The odds ratio was only slightly increased for diabetes lasting less than 15 years, but the ratio increased more than 20-fold for diabetes lasting 15 years or more. The population-attributable risk for kidney failure was 21% for insulin-dependent diabetes and 21% for non-insulin-dependent diabetes (42% overall). A similar proportion of end-stage renal disease was attributed to diabetes in whites (44%) and in blacks (41%). Insulin-dependent diabetes had a relatively greater effect on the incidence of kidney failure in whites; in contrast, non-insulin-dependent diabetes had a relatively greater effect on kidney failure in blacks.


CONCLUSIONS
Diabetes mellitus has a major effect on the incidence of end-stage renal disease in nonelderly adults. In black persons, diabetes may be responsible for a larger proportion of end-stage renal disease than is suggested by the use of clinical diagnoses of underlying renal disease made by patients' nephrologists. Prevention of end-stage renal disease associated with diabetes mellitus (both insulin-dependent and non-insulin-dependent diabetes) requires increased attention from laboratory and clinical researchers.
Johns Hopkins University School of Hygiene and Public Health and School of Medicine, Baltimore, Maryland.
T V
TV
Perneger
F L
FL
Brancati
P K
PK
Whelton
M J
MJ
Klag
D000328:Adult; D001741:Black or African American; D017668:Age of Onset; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D003663:Decision Trees; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology; D003928:Diabetic Nephropathies / Q000209:etiology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D044465:White People