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NDT Advance Access originally published online on October 26, 2004
Nephrology Dialysis Transplantation 2004 19(12):3098-3103; doi:10.1093/ndt/gfh540
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Nephrol Dial Transplant Vol. 19 No. 12 © ERA-EDTA 2004; all rights reserved

Original Article

The growing volume of diabetes-related dialysis: a population based study

Charmaine E. Lok1,2, Matthew J. Oliver3, Deanna M. Rothwell2 and Janet E. Hux2,3

1 Division of Nephrology, University Health Network, Toronto General Hospital, 2 Institute for Clinical Evaluative Sciences and 3 Department of Medicine, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada

Correspondence and offprint requests to: Charmaine E. Lok, MD, Department of Medicine, Division of Nephrology, The Toronto General Hospital, 11 EN-216, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. Email: charmaine.lok{at}uhn.on.ca

Background. End-stage renal failure requiring dialysis is one of the most serious complications of diabetes mellitus, and diabetes is the most common cause of end-stage renal failure. The aim of this large, observational study is to describe the population-based incidence and prevalence rates and outcomes of diabetic individuals in Ontario, Canada who require dialysis therapy.

Methods. Two cohorts of patients, those with diabetes and those without, were created between April 1, 1994 and March 31, 2000 (total of ~8.4 million) and followed until March 31, 2001 using several large, linked administrative databases at the Institute for Clinical Evaluative Sciences. The incidence, prevalence and mortality on dialysis for each cohort were determined. A multivariate Cox proportional hazards analysis, adjusting for age, sex and co-morbidity, was used to determine the independent impact of diabetes on patient survival.

Results. The average annual incidence rate of dialysis was 12 times greater in persons with diabetes (130 per 100 000) vs without diabetes (11 per 100 000). By 1999–2000, diabetic patients comprised 51% of the incident dialysis population. The average annual prevalence rate was 10 times greater in the diabetic cohort. Patients with diabetes had more co-morbidities at the start of dialysis and poorer 3 year survival (55 vs 68%; P<0.0001).

Conclusions. The incident and prevalent rates of dialysis for patients with diabetes mellitus are many times the rates of those without diabetes. Patients with diabetes mellitus often start dialysis with significant co-morbidities, which may contribute to the relatively high rate of mortality on dialysis.

Keywords: diabetes; dialysis; population study; survival


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