title: Mortality and incidence of renal replacement therapy in people with type 1 diabetes mellitus--a three decade long prospective observational study in the Lainz T1DM cohort.
abstract: OBJECTIVE
  We investigated long term mortality, requirement for renal replacement therapy (RRT), and incidence of other late diabetic complications in an observational cohort study of 641 people with type 1 diabetes (T1DM).
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  The study was conducted at a Tertiary Diabetes Centre in Vienna, Austria.
  
  
  METHODS
  A cohort with all people with T1DM (n = 641, 47% females, 30 ± 11 years) attending their annual diabetes review was created in 1983-1984. Biomedical data were collected.
  
  
  METHODS
  In 2013 we investigated mortality rates and incidence rates of RRT by record linkage with national registries and incidence of other major diabetes complications by questionnaire.
  
  
  RESULTS
  156 (24%) patients died [mortality rate: 922 (95%CI: 778-1066) per 100 000 person years]. Fifty-five (8.6%) received RRT [incidence rate: 335 (95%CI: 246-423) per 100 000 person years]. The 380 questionnaires (78% return rate) recorded cardiac events, strokes, limb amputations, and/or blindness, affecting 21.8% of survivors. Mortality and incidence of RRT increased in each quartile of baseline HbA1c, with the lowest rates in the quartile with HbA1c ≤ 6.5% (48 mmol/mol) (P < .05).
  
  
  CONCLUSIONS
  In people with established type 1 diabetes who were observed for almost three decades, the overall mortality was 24% and the incidence of renal replacement therapy was 8.6%, with a 21.8% combined incidence rate of the other hard endpoints in the surviving people. A clear linear relationship between early glycemic control and the later development of end stage renal disease and mortality has been found.
authors.affiliation: Third Medical Department (M.S., M.A., R.P.), Hietzing Hospital Vienna Wolkersbergenstr. 1, 1130 Vienna, Austria; Diabetes Research Group (M.S., S.A.A.), King's College London, 10, Cutcombe Road, SE5 9RJ London, United Kingdom; Karl-Landsteiner Institute of Metabolic Diseases and Nephrology (S.P., H.S-K., T.K., R.P.), Hietzing Hospital Vienna, Wolkersbergenstr. 1, 1130 Vienna, Austria; Former Ludwig Boltzmann Institute for Metabolic Diseases and Diabetes (K.I.), 1130 Vienna, Austria; Austrian Dialysis and Transplantation Registry (R.K.), Klinikum Kreuzschwestern, Grieskirchner Strasse 42, 4600 Wels, Austria; Department of Ophthalmology (A.R.), Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; Department of Medical Genetics (F.K.), Division of Genetic Epidemiology, Innsbruck Medical University, Schöpfst. 41, 6020 Innsbruck Austria.
authors.forename: Marietta
authors.initials: M
authors.lastname: Stadler
authors.forename: Slobodan
authors.initials: S
authors.lastname: Peric
authors.forename: Hermine
authors.initials: H
authors.lastname: Strohner-Kaestenbauer
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Thomas
authors.initials: T
authors.lastname: Kaestenbauer
authors.forename: Andreas
authors.initials: A
authors.lastname: Reitner
authors.forename: Martin
authors.initials: M
authors.lastname: Auinger
authors.forename: Florian
authors.initials: F
authors.lastname: Kronenberg
authors.forename: Karl
authors.initials: K
authors.lastname: Irsigler
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Amiel
authors.forename: Rudolf
authors.initials: R
authors.lastname: Prager
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D015331:Cohort Studies; D048909:Diabetes Complications / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000401:mortality; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires