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Ten-year comparative analysis of incidence, prognosis, and associated factors for dialysis and renal transplantation in type 1 and type 2 diabetes versus non-diabetes

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Abstract

Aims

To study the incidence of and the factors associated with renal dialysis and transplantation in type 1 (T1DM) and type 2 diabetes (T2DM).

Methods

Data on individuals who had received dialysis treatment or renal transplant between 1 January 2004 and 31 December 2013 were extracted from the regional administrative database (Piedmont, Italy), and the crude (cumulative) incidence of dialysis was calculated. Overall cumulative survival was estimated using the Kaplan–Meier method and compared using the log-rank test. Poisson regression was used to estimate adjusted rate ratios for potential predictors of renal transplant or death.

Results

A total of 7401 persons started dialysis treatment during the decade, with a 10-year cumulative crude incidence of 16.8/100,000. Incidence was stable and consistently eightfold higher in persons with T2DM (tenfold higher in T1DM) compared to those without diabetes. The risk of dialysis in T1DM was about double that of T2DM. The mortality rate was significantly higher in diabetics than in non-diabetes (241.4/1000 vs. 153.99/1000 person-years). During the decade 2004–2013, 893 patients underwent a kidney transplant. Transplantation rates were significantly lower for diabetics than non-diabetics (16.5/1000 vs. 42.9/1000 person-years).

Conclusions

In the past decade, the incidence of dialysis has stabilized in both the general population and in diabetics in whom it remains far higher by comparison. Also mortality rates are higher, with a worse prognosis for T1DM. Diabetes poses a barrier to allotransplantation, and efforts should be made to overcome this limitation.

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Acknowledgements

CBG and RG contributed to the literature search, study design, data collection, data interpretation, and writing; PC and RP helped in data analysis and interpretation; MS and GC contributed to data interpretation; and BT helped in the literature search and writing support. Dr. Carlo Giorda is the guarantor of this work and, as such, had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. He confirms that all authors consent to publication of this manuscript. There is no funding to report for this submission.

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Authors and Affiliations

  1. Diabetes and Endocrine Unit, ASL TO5, Via De Maria, 1, 10023, Chieri, TO, Italy

    Carlo Bruno Giorda

  2. Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, TO, Italy

    Paolo Carnà, Roberta Picariello, Giuseppe Costa & Roberto Gnavi

  3. Nephrology Unit, ASL TO5, Chieri, TO, Italy

    Mario Salomone

  4. Department of Clinical and Biological Science, University of Turin, Turin, Italy

    Giuseppe Costa

  5. Chaira Medica Association, Chieri, Italy

    Barbara Tartaglino

Authors
  1. Carlo Bruno Giorda
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  2. Paolo Carnà
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  3. Mario Salomone
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  4. Roberta Picariello
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  5. Giuseppe Costa
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  6. Barbara Tartaglino
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  7. Roberto Gnavi
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Corresponding author

Correspondence to Carlo Bruno Giorda.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This is an observational study and data were collected retrospectively. The Local Health Authority of Piedmont region was responsible for collecting and processing these data. The study was commissioned by the Local Health Authority. No ethical approval was required according to Italian law 211/2003, which explains that no ethics committee permission is required for this kind of study.

Informed consent

According to Italian privacy law, no patient’s or relative’s consent is required for large retrospective population-based studies and if data are published only in aggregated form.

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Managed by Antonio Secchi.

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Giorda, C.B., Carnà, P., Salomone, M. et al. Ten-year comparative analysis of incidence, prognosis, and associated factors for dialysis and renal transplantation in type 1 and type 2 diabetes versus non-diabetes. Acta Diabetol 55, 733–740 (2018). https://doi.org/10.1007/s00592-018-1142-y

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  • DOI: https://doi.org/10.1007/s00592-018-1142-y

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