Cumulative risk, age at onset and sex-specific differences for developing end-stage renal disease in young patients with type 1 diabetes. A nationwide population based cohort study.

  1. the Swedish Renal Registry
  1. 1Department of Clinical Sciences, Pediatrics, Umeå University, Umeå
  2. 2Dept of Nephrology, Sahlgrenska University Hospital, Gothenburg
  3. 3Department of Statistics, Umeå university
  4. 4Department of Pediatrics, Sunderbyn Hospital, Luleå
  5. 5Department of Internal Medicine, Ryhov County Hospital, Jönköping
  6. 6Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umeå University, Umeå
  7. 7Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden

Abstract

Objective – This study aimed to estimate the current cumulative risk of ESRD due to diabetic nephropathy in a large nationwide population-based prospective type 1 diabetes cohort and specifically study the effects of sex and age at onset.

Research design and methods – In Sweden, all incident cases of type 1 diabetes aged 0-14 years and 15-34 years are recorded in validated research registers since 1977 and 1983 respectively. These registers were linked to the Swedish Renal Registry that, since 1991, collects data on patients who receive active uremia treatment. Patients with ≥13 years duration of type 1 diabetes were included (n=11,681).

Results – During a median time of follow-up of 20 years 127 patients had developed ESRD due to diabetic nephropathy. The cumulative incidence at 30 years of type 1 diabetes duration was low with a male predominance, 4.1% (95%CI 3.1-5.3) vs. 2.5% (95%CI 1.7-3.5). In both males and females, onset of type 1 diabetes before 10 years of age was associated with the lowest risk of developing ESRD. The highest risk of ESRD was found in males diagnosed at 20-34 years, hazard ratio=3.0 (95% CI: 1.5-5.7). In females with onset 20-34 years the risk was similar to patients' diagnosed before 10.

Conclusions – The cumulative incidence of ESRD is exceptionally low in young type 1 diabetes patients in Sweden. There is a striking difference in risk for male compared with female patients. The different patterns of risk by age at onset and sex suggest a role for puberty and sex hormones.

Footnotes

    • Received November 27, 2009.
    • Accepted April 12, 2010.

This Article

  1. Diabetes
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