title: Competing-risk analysis of ESRD and death among patients with type 1 diabetes and macroalbuminuria.
abstract: Patients with both type 1 diabetes and CKD have an increased risk of adverse outcomes. The competing risks of death and ESRD may confound the estimates of risk for each outcome. Here, we sought to determine the major predictors of the cumulative incidence of ESRD and pre-ESRD mortality in patients with type 1 diabetes and macroalbuminuria while incorporating the competing risk for the alternate outcome into a Fine-Gray competing-risks analysis. We followed 592 patients with macroalbuminuria for a median of 9.9 years. During this time, 56 (9.5%) patients died and 210 (35.5%) patients developed ESRD. Predictors of incident ESRD, taking baseline renal function and the competing risk for death into account, included an elevated HbA(1c), elevated LDL cholesterol, male sex, weight-adjusted insulin dose, and a shorter duration of diabetes. By contrast, predictors of pre-ESRD death, taking baseline renal function and the competing risk for ESRD into account, included only age, the presence of established macrovascular disease, and elevated cholesterol levels. This competing-risks approach has potential to highlight the appropriate targets and strategies for preventing premature mortality in patients with type 1 diabetes.
authors.affiliation: Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, University of Helsinki, Finland.
authors.forename: Carol
authors.initials: C
authors.lastname: Forsblom
authors.forename: Valma
authors.initials: V
authors.lastname: Harjutsalo
authors.forename: Lena M
authors.initials: LM
authors.lastname: Thorn
authors.forename: Johan
authors.initials: J
authors.lastname: Wadén
authors.forename: Nina
authors.initials: N
authors.lastname: Tolonen
authors.forename: Markku
authors.initials: M
authors.lastname: Saraheimo
authors.forename: Daniel
authors.initials: D
authors.lastname: Gordin
authors.forename: John L
authors.initials: JL
authors.lastname: Moran
authors.forename: Merlin C
authors.initials: MC
authors.lastname: Thomas
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Groop
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000150:complications* / Q000453:epidemiology; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate