Predominant effect of kidney disease on mortality in Pima Indians with or without type 2 diabetes.
BACKGROUND
We examined the effect of kidney disease (KD) on mortality in nondiabetic and diabetic Pima Indians aged > or = 45 years old.


METHODS
Deaths and person-years of follow-up were stratified in a time-dependent fashion into categories of (1) no proteinuria and normal serum creatinine (SCr); (2) proteinuria and normal SCr; (3) high SCr [SCr > or = 133 micromol/L (1.5 mg/dL) in men, > or = 124 micromol/L (1.4 mg/dL) in women] but not on renal replacement therapy (RRT); or (4) RRT.


RESULTS
Among 1993 subjects, 55.8% had type 2 diabetes at baseline. Overall death rates increased with declining kidney function in both the nondiabetic and diabetic subjects (P < 0.0001). Death rates were similar in nondiabetic and diabetic subjects with comparable levels of kidney function, although the number of deaths among nondiabetic subjects with advanced KD was small. Infections and malignancy were the leading causes of death in nondiabetic subjects with KD. Among diabetic subjects, overall mortality increased with diabetes duration (P = 0.0001) and was highest in those on RRT (P < 0.0001). High SCr was associated with higher death rates from cardiovascular disease (CVD), diabetic nephropathy (DN), infections, and malignancy.


CONCLUSIONS
Death rates increased comparably with worsening kidney function in both nondiabetic and diabetic subjects and were similar in nondiabetic and diabetic subjects without KD. KD was associated with excess mortality from DN, CVD, infections, and malignancy in diabetic subjects, and from infections in those without diabetes.
Pavkov
Meda E
ME
Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona 85014-4972, USA. mpavkov@phx.niddk.nih.gov
Bennett
Peter H
PH
Sievers
Maurice L
ML
Krakoff
Jonathan
J
Williams
Desmond E
DE
Knowler
William C
WC
Nelson
Robert G
RG
D000328:Adult; D001130:Arizona / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged