Thomas V. Perneger, MD, PhD; Frederick L. Brancati, MD, MHS; Paul K. Whelton, MD, MSc; Michael J. Klag, MD, MPH
To determine the proportion of end-stage renal disease associated with diabetes mellitus in a biracial population, using population-attributable risk estimates.
Population-based study in Maryland, Virginia, West Virginia, and Washington, D.C.
716 newly treated patients with kidney failure aged 20 to 64 years and 361 age-matched controls.
Self-reported history of diabetes mellitus, including type, duration, treatment, and complications.
Persons with insulin-dependent diabetes (odds ratio, 33.7) and non–insulin-dependent diabetes (odds ratio, 7.0) were at greater risk for end-stage renal disease than were persons without diabetes. The odds ratio was only slightly increased for diabetes lasting less than 15 years, but the ratio increased more than 20-fold for diabetes lasting 15 years or more. The population-attributable risk for kidney failure was 21% for insulin-dependent diabetes and 21% for non–insulin-dependent diabetes (42% overall). A similar proportion of end-stage renal disease was attributed to diabetes in whites (44%) and in blacks (41%). Insulin-dependent diabetes had a relatively greater effect on the incidence of kidney failure in whites; in contrast, non–insulin-dependent diabetes had a relatively greater effect on kidney failure in blacks.
Diabetes mellitus has a major effect on the incidence of end-stage renal disease in nonelderly adults. In black persons, diabetes may be responsible for a larger proportion of end-stage renal disease than is suggested by the use of clinical diagnoses of underlying renal disease made by patients' nephrologists. Prevention of end-stage renal disease associated with diabetes mellitus (both insulin-dependent and non–insulin-dependent diabetes) requires increased attention from laboratory and clinical researchers.
Perneger TV, Brancati FL, Whelton PK, Klag MJ. End-Stage Renal Disease Attributable to Diabetes Mellitus. Ann Intern Med. ;121:912–918. doi: 10.7326/0003-4819-121-12-199412150-00002
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Published: Ann Intern Med. 1994;121(12):912-918.
Cardiology, Chronic Kidney Disease, Coronary Risk Factors, Diabetes, Diabetic Nephropathy.
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