Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway.
Diabetes Care. 2018 Mar;41(3):420-425. doi: 10.2337/dc17-0906. Epub 2017 Oct 12.
End-stage renal disease (ESRD) is one of the most severe complications in type 1 diabetes. We aimed to estimate the cumulative incidence of ESRD in individuals with childhood-onset type 1 diabetes followed for up to 42 years.
Data were based on the nationwide, population-based Norwegian Childhood Diabetes Registry and included case patients with new-onset type 1 diabetes (age <15 years) who had received a diagnosis during the periods 1973-1982 and 1989-2012. Follow-up took place until the development of ESRD, death, emigration, or 30 November 2015. We estimated the cumulative incidence of ESRD by linking to the Norwegian Renal Registry.
Among the 7,871 patients, representing 147,714 person-years of follow-up, ESRD developed in 103 individuals (1.3%). The mean time from the diagnosis of diabetes to the development of ESRD was 25.9 years (range 12.7-39.1). The cumulative incidence of ESRD was 0.7% (95% CI 0.4-1.0) at 20 years' diabetes duration, 2.9% (2.3-3.7) at 30 years' duration, and 5.3% (4.3-6.5) at 40 years' duration. The risk of the development of ESRD was lower in women than in men (hazard ratio [HR] 0.61; 95% CI 0.41-0.91) and higher in individuals in whom diabetes had been diagnosed at 10-14 years of age compared with those in whom it was diagnosed before 10 years of age (HR 1.29; 1.06-1.56). We did not identify any significant difference in the risk of the development of ESRD between those in whom diabetes was diagnosed in 1973-1982 and in 1989-2012 (HR 0.80; 0.45-1.45).
We report a very low incidence of ESRD among patients with childhood-onset diabetes in Norway. The risk was lower in women compared with men and in individuals in whom diabetes was diagnosed at a younger age.
终末期肾病（ESRD）是 1 型糖尿病最严重的并发症之一。本研究旨在估计随访时间长达 42 年的儿童期起病 1 型糖尿病患者中 ESRD 的累积发生率。
数据基于全国性的、基于人群的挪威儿童期糖尿病登记处，包括新诊断的 1 型糖尿病（年龄＜15 岁）患者，这些患者的诊断时间分别为 1973-1982 年和 1989-2012 年。随访至 ESRD 发生、死亡、移民或 2015 年 11 月 30 日。我们通过与挪威肾脏登记处链接来估计 ESRD 的累积发生率。
在 7871 名患者中（代表 147714 人年的随访时间），有 103 人（1.3%）发生 ESRD。从糖尿病诊断到 ESRD 发生的平均时间为 25.9 年（范围 12.7-39.1）。20 年糖尿病病程时 ESRD 的累积发生率为 0.7%（95%CI 0.4-1.0），30 年时为 2.9%（2.3-3.7），40 年时为 5.3%（4.3-6.5）。与男性相比，女性发生 ESRD 的风险较低（危险比[HR]0.61；95%CI 0.41-0.91），与 10 岁前确诊糖尿病的患者相比，10-14 岁确诊的患者发生 ESRD 的风险更高（HR 1.29；1.06-1.56）。我们未发现 1973-1982 年和 1989-2012 年诊断的患者发生 ESRD 的风险存在显著差异（HR 0.80；0.45-1.45）。
本研究报告了挪威儿童期起病糖尿病患者中非常低的 ESRD 发生率。女性的风险低于男性，且在较年轻发病的患者中风险较低。
