NDT Advance Access published online on October 21, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp555
Improved survival of type 2 diabetic patients on renal replacement therapy in Finland
1 Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland 2 Department of Internal Medicine, Oulu University Hospital, Oulu, Finland 3 Finnish Registry for Kidney Diseases, Helsinki, Finland 4 Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland 5 School of Public Health, University of Tampere, Tampere, Finland
Correspondence and offprint requests to: Correspondence and offprint requests to: Dr. Marjo Kervinen; E-mail: marjo.kervinen{at}kuh.fi
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Abstract |
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Background. Survival of type 2 diabetes mellitus patients on maintenance dialysis therapy is poor mainly due to cardiovascular events. The aim was to examine whether survival of type 2 diabetes patients on renal replacement therapy (RRT) in Finland has improved during 1995–2005.
Methods. Patients who entered RRT because of type 2 diabetes mellitus in 1995–99 (n = 314) and 2000–05 (n = 583) were identified within the Finnish Registry for Kidney Diseases. The two cohorts were followed up from start of RRT until death or end of follow-up on 31 December 2006. Survival probabilities and probabilities of receiving a kidney transplant were calculated using Kaplan–Meier curves. Multivariate modelling was performed using Cox regression.
Results. Patients who entered RRT in 2000–05 had lower risk of dying than those who entered in 1995–99; hazard ratio (HR) was 0.76 (95% CI 0.65–0.89) and 0.74 (95% CI 0.63–0.87) with adjustment for age and gender. The decreased risk of death was most obvious in age groups 55–64 (HR 0.67, 95% CI 0.49–0.92) and 65–74 years (HR 0.69, 95% CI 0.56–0.87). Adjustment for albumin in addition to age and gender only slightly weakened the effect of study periods (HR 0.83, 95% CI 0.69–1.01). The patients in 2000–05 were more obese, had lower total and LDL cholesterol and higher HDL cholesterol and albumin concentration in serum than patients in 1995–99. Patients' probability to receive a kidney transplant was low in both groups.
Conclusions. Survival of type 2 diabetes patients on RRT improved during the time period 1995–2005 in Finland while the probability of receiving a kidney transplant remained low and unchanged.
Keywords: diabetes mellitus; end-stage renal disease; survival
Received for publication: 1. 5.09
Revision received 18. 9.09.
Accepted in revised form: 24. 9.09