Incidence of end-stage renal disease in patients with type 1 diabetes
Incidence of end-stage renal disease in patients with type 1 diabetes
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DOI：
10.1001/jama.294.14.1782
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发表时间：
2005-10-12
影响因子：
120.7
通讯作者：
Grönhagen-Riska, C
中科院分区：
文献类型：
--
作者：
Finne, P;Reunanen, A;Grönhagen-Riska, C
终末期肾病（ESRD）是1型糖尿病最严重的并发症之一。然而，关于患者发生ESRD风险的数据很少。目的评估发生ESRD的长期风险，并评估糖尿病诊断年龄、诊断时间和性别对风险的影响。设计、环境和患者从芬兰糖尿病登记册中确定了1965-1999年芬兰所有年龄小于30岁诊断为1型糖尿病的患者（n=20005）。该队列从诊断为糖尿病开始随访，直到发生ESRD（从芬兰肾脏疾病登记处确定的透析或肾移植）、死亡或2001年12月31日随访结束。主要结局指标ESRD的累积发生率，将死亡作为竞争风险。结果该队列最长随访37年，中位随访16.7年。在346851人年期间，632名患者发生了ESRD。ESRD的累积发病率在诊断后20年为2.2%，30年为7.8%。发生ESRD的风险在小于5岁的患者中最低。晚期诊断为1型糖尿病的患者发生ESRD的风险较低。这种风险在性别之间没有显著差异。结论在ESRD方面，1型糖尿病的预后在过去40年中有所改善。5岁前被诊断患有糖尿病的儿童预后最好。总的来说，ESRD的发病率似乎比以前估计的要低。
Context End-stage renal disease (ESRD) is one of the most severe complications of type 1 diabetes. Yet, data on patients' risk of developing ESRD are sparse.Objectives To estimate the long-term risk of developing ESRD and to assess how age at diagnosis of diabetes, time period of diagnosis, and sex affect the risk.Design, Setting, and Patients A cohort of all patients younger than 30 years diagnosed as having type 1 diabetes in Finland in 1965-1999 (n=20005)was identified from the Finnish Diabetes Register. The cohort was followed up from diagnosis of diabetes until development of ESRD (dialysis or kidney transplantation as identified from the Finnish Registry for Kidney Diseases), death, or end of follow-up on December 31, 2001.Main Outcome Measure Cumulative incidence of ESRD, accounting for death as a competing risk.Results The cohort was followed up for maximally 37 years, with a median of 16.7 years. During 346851 person-years, 632 patients developed ESRD. The cumulative incidence of ESRD was 2.2% at 20 years and 7.8% at 30 years after diagnosis. The risk of developing ESRD was lowest in patients whose diagnosis occurred at younger than 5 years. The risk of ESRD was lower for patients diagnosed as having type 1 diabetes in later years. The risk did not differ significantly between sexes.Conclusions With regard to ESRD, the prognosis of type 1 diabetes has improved during the past 4 decades. Children diagnosed as having diabetes before age 5 years have the most favorable prognosis. Overall, incidence of ESRD appears to be lower than previously estimated.