TY - JOUR
T1 - Excess all-cause and cause-specific mortality for people with diabetes and end-stage kidney disease
AU - Morton, Jedidiah I.
AU - Sacre, Julian W.
AU - McDonald, Stephen P.
AU - Magliano, Dianna J.
AU - Shaw, Jonathan E.
N1 - Funding Information:
J.I.M. is supported by an Australian Government Research Training Program (RTP) Scholarship and Monash Graduate Excellence Scholarship. J.E.S. is supported by a National Health and Medical Research Council Investigator Grant. D.J.M. is supported by a National Health and Medical Research Council Senior Research Fellowship. This work is partially supported by the Victorian Government's Operational Infrastructure Support Program. The ANZDATA Registry is funded by the Australian Organ and Tissue Authority, the New Zealand Ministry of Health and Kidney Health Australia. The data here have been supplied by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the Australia and New Zealand Dialysis and Transplant Registry.
Funding Information:
J.I.M. is supported by an Australian Government Research Training Program (RTP) Scholarship and Monash Graduate Excellence Scholarship. J.E.S. is supported by a National Health and Medical Research Council Investigator Grant. D.J.M. is supported by a National Health and Medical Research Council Senior Research Fellowship. This work is partially supported by the Victorian Government's Operational Infrastructure Support Program. The ANZDATA Registry is funded by the Australian Organ and Tissue Authority, the New Zealand Ministry of Health and Kidney Health Australia.
Publisher Copyright:
© 2021 Diabetes UK.
PY - 2022/6
Y1 - 2022/6
N2 - Aims: Excess mortality is high in the setting of diabetes and end-stage kidney disease (ESKD), but the effects of ESKD beyond diabetes itself remains incompletely understood. We examined excess mortality in people with diabetes with versus without ESKD, and variation by age, sex and diabetes type. Methods: This study included 63,599 people with type 1 (aged 20–69 years; 56% men) and 1,172,160 people with type 2 diabetes (aged 30+ years; 54% men), from the Australian National Diabetes Services Scheme. Initiation of renal replacement therapy and mortality outcomes were obtained via linkage to the Australia and New Zealand Dialysis and Transplant Registry and the National Death Index, respectively. Excess mortality was measured by calculating the mortality rate ratio (MRR) for people with versus without ESKD via indirect standardisation. Results: A total of 9027 people developed ESKD during 8,601,522 person-years of follow-up. Among people with type 1 diabetes, the MRR was 34.9 (95%CI: 16.6–73.1) in men and 41.5 (20.8–83.1) in women aged 20–29 years and was 5.6 (4.5–7.0) and 7.4 (5.5–10.1) in men and women aged 60–69 years, respectively. In type 2 diabetes, MRRs were 16.6 (8.6–31.8) and 35.8 (17.0–75.2) at age 30–39 years and were 2.8 (2.6–3.1) and 3.6 (3.2–4.1) at age 80+ years in men and women, respectively. Excess cause-specific mortality was highest for peripheral artery disease, cardiac arrest, and infections, and lowest for cancer. Conclusions: Among people with diabetes, excess mortality in ESKD is much higher at younger ages and is higher for women compared with men.
AB - Aims: Excess mortality is high in the setting of diabetes and end-stage kidney disease (ESKD), but the effects of ESKD beyond diabetes itself remains incompletely understood. We examined excess mortality in people with diabetes with versus without ESKD, and variation by age, sex and diabetes type. Methods: This study included 63,599 people with type 1 (aged 20–69 years; 56% men) and 1,172,160 people with type 2 diabetes (aged 30+ years; 54% men), from the Australian National Diabetes Services Scheme. Initiation of renal replacement therapy and mortality outcomes were obtained via linkage to the Australia and New Zealand Dialysis and Transplant Registry and the National Death Index, respectively. Excess mortality was measured by calculating the mortality rate ratio (MRR) for people with versus without ESKD via indirect standardisation. Results: A total of 9027 people developed ESKD during 8,601,522 person-years of follow-up. Among people with type 1 diabetes, the MRR was 34.9 (95%CI: 16.6–73.1) in men and 41.5 (20.8–83.1) in women aged 20–29 years and was 5.6 (4.5–7.0) and 7.4 (5.5–10.1) in men and women aged 60–69 years, respectively. In type 2 diabetes, MRRs were 16.6 (8.6–31.8) and 35.8 (17.0–75.2) at age 30–39 years and were 2.8 (2.6–3.1) and 3.6 (3.2–4.1) at age 80+ years in men and women, respectively. Excess cause-specific mortality was highest for peripheral artery disease, cardiac arrest, and infections, and lowest for cancer. Conclusions: Among people with diabetes, excess mortality in ESKD is much higher at younger ages and is higher for women compared with men.
KW - diabetes complications
KW - diabetes mellitus, type 1
KW - diabetes mellitus, type 2
KW - kidney failure, chronic
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85122102294&partnerID=8YFLogxK
U2 - 10.1111/dme.14775
DO - 10.1111/dme.14775
M3 - Article
C2 - 34951712
AN - SCOPUS:85122102294
VL - 39
JO - Diabetic Medicine
JF - Diabetic Medicine
SN - 0742-3071
IS - 6
M1 - e14775
ER -