Incidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: a report from the Allegheny County Registry.

BACKGROUND: Little information is available regarding the long-term incidence of end-stage renal disease (ESRD) and survival after the introduction of renal replacement therapy (RRT) in patients with type 1 diabetes.

METHODS: We studied 1,075 patients with type 1 diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who comprise the Allegheny County population-based registry. Onset of ESRD was defined as the introduction of RRT (dialysis or transplantation).

RESULTS: Of 1,075 registrants, the living status of 975 patients (90.7%) and complication status of 798 patients (74.2%) were ascertained as of January 1, 1999. During the observation period, 104 patients (13.0%) developed ESRD, for an incidence rate of 521/100,000 person-years (95% confidence interval, 424 to 629). The cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant decline was observed in 20-year cumulative incidence rates of ESRD for patients diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%, and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients (28%) received dialysis alone, 44 patients (42%) received dialysis followed by kidney transplantation, 26 patients (25%) underwent successful transplantation alone, and 5 patients (5%) underwent a failed kidney transplantation followed by dialysis therapy. The cumulative survival rate 10 years after the introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy followed by kidney transplantation was significantly greater than that of dialysis therapy alone (P < 0.001). No difference was detected in survival between pancreas-kidney transplant recipients and kidney-alone transplant recipients (P = 0.7).

CONCLUSION: The incidence of ESRD observed in this cohort has declined, probably reflecting the better glycemic and blood pressure control available since the early 1980s.