[Has the incidence of end-stage renal disease increased in diabetic patients? A center-based longitudinal study over 10 years].
OBJECTIVE
Worldwide, the incidence of diabetic patients requiring renal replacement therapy seems to be on the rise. Whether this assumption holds true also for Germany was investigated on the basis of three long-standing centers for dialysis in the catchment area of Dusseldorf.


METHODS
All patients entering long-term dialysis between 1990 and 1999 were analyzed in retrospect according to their charts. The following items were evaluated as documented: diagnosis, type, and duration of diabetes mellitus; diabetic neuropathy and retinopathy; amputations; causes of hemodialysis.


RESULTS
Between 1990 and 1999, a total of 657 patients (379 men, 278 women) entered hemodialysis. The mean entering rate remained at 67/year between 1990 and 1994 and at 64/year between 1995 and 1999 (n.s.). The mean age of all patients at entering dialysis increased significantly from 59 years between 1990 and 1994 to 62 years between 1995 and 1999 (p = 0.0069). A total of 243 patients were known diabetics; their mean entering rate of 24/year between 1990 and 1994 continued at 25/year between 1995 and 1999 (n.s.). The mean age of the diabetic patients increased from 62 years between 1990 and 1994 to 66 years between 1995 and 1999 (p = 0.0238). However, the proportion of diabetic patients entering dialysis remained unchanged at approximately 37% over the 10-year time period (Cochran-Armitage trend test; p = 0.1568). Of all diabetic patients, 92 had proven diabetic retinopathy, 33 were amputated, and 38 had neuropathy. In 37% the medical records did not mention any etiology of end-stage renal disease in diabetic patients, 29% were nondiabetic causes, and 34% were said to be diabetic nephropathy.


CONCLUSIONS
The incidence of patients with end-stage renal disease entering hemodialysis has not changed between 1990 and 1999, and the proportion of diabetic patients has remained the same. However, the patients' age at entering hemodialysis has increased significantly between 1990 and 1999. As the documentation in the patients' records was unsatisfactory with regard to diabetes history and causes for dialysis, the results of the present study need to be interpreted with caution.
Van Landeghem
Martin A
MA
Diabetesambulanz MNR-Klinik, Klinik für Endokrinologie, Diabetologie und Rheumatologie, Heinrich-Heine-Universität, Düsseldorf. MVanLandeghem@web.de
D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005858:Germany; D006436:Hemodialysis Units, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014505:Urban Population / Q000706:statistics & numerical data