Survival of patients with type 1 diabetes receiving renal replacement therapy in 1980-2007.
OBJECTIVE
Risks of end-stage renal disease and premature death in patients with type 1 diabetes have declined over the past decades. Data on the survival of patients receiving renal replacement therapy (RRT) are, however, limited. We investigated whether survival of patients with type 1 diabetes receiving RRT has improved over time and whether improvement can be attributable to progress in dialysis treatment or diabetes care.


METHODS
An incident cohort of all patients with type 1 diabetes (n = 1,604) starting chronic RRT in Finland between 1980 and 2005 were followed until death or end of follow-up on 31 December 2007. The control group (n = 1,556) consisted of patients with glomerulonephritis who started RRT. All patients were identified from the Finnish Registry for Kidney Diseases.


RESULTS
Median survival time of patients with type 1 diabetes increased progressively from 3.60 years during 1980-1984 to >8 years in 2000-2005. In 2000-2005, the unadjusted relative risk of death was 0.55 compared with 1980-1984. After adjustment for the most important variables, the corresponding relative risk of death was only 0.23. For patients with glomerulonephritis, the adjusted relative risk decreased to a lesser extent to 0.30 (P = 0.007).


CONCLUSIONS
Survival of patients with type 1 diabetes and end-stage renal disease has improved since the 1980s despite a conspicuous increase in the age of patients who start RRT, suggesting not only true progress in dialysis therapy and overall treatment of patients with end-stage renal disease but possibly also improved management of diabetes.
Haapio
Mikko
M
Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland. mikko.haapio@hus.fi
Helve
Jaakko
J
Groop
Per-Henrik
PH
Grönhagen-Riska
Carola
C
Finne
Patrik
P
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy