Finnish Registry for Kidney Diseases, Helsinki, Finland
Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Diabetes Care. 2018 Mar;41(3):434-439. doi: 10.2337/dc17-2364. Epub 2017 Dec 20.
To investigate how risk of end-stage renal disease (ESRD) among patients with type 1 diabetes has changed over time and further how the risk is affected by age, sex, and time period of diagnosis of diabetes.
A cohort including all patients <30 years old diagnosed with type 1 diabetes in Finland in 1965-2011 was followed until start of renal replacement therapy, death, or end of follow-up at the end of 2013. Altogether, 29,906 patients were included. The main outcome was cumulative risk of ESRD, accounting for death as a competing risk.
The patients were followed up for a median of 20 years. During 616,403 patient-years, 1,543 ESRD cases and 4,185 deaths were recorded. The cumulative risk of ESRD was 2.2% after 20 years and 7.0% after 30 years from the diabetes diagnosis. The relative risk of ESRD was 0.13 (95% CI 0.08-0.22) among patients diagnosed in 1995-2011 compared with those diagnosed in 1965-1979. Patients <5 years old at the time of diagnosis had the lowest risk of ESRD after diagnosis. With the cumulative risk of ESRD estimated from time of birth, the patients aged 5-9 years at diabetes diagnosis were at highest risk.
The cumulative risk of ESRD has decreased markedly during the past five decades. This highlights the importance of modern treatment of diabetes and diabetic nephropathy.
研究 1 型糖尿病患者终末期肾病（ESRD）的风险随时间变化的情况，以及该风险如何受年龄、性别和糖尿病诊断时间的影响。
一项队列研究纳入了芬兰所有 1965 年至 2011 年间被诊断为 1 型糖尿病且年龄<30 岁的患者，随访至开始接受肾脏替代治疗、死亡或随访结束（2013 年底）。共纳入 29906 例患者。主要结局是 ESRD 的累积风险，将死亡视为竞争风险。
患者中位随访时间为 20 年。在 616403 患者-年中，有 1543 例 ESRD 病例和 4185 例死亡。糖尿病诊断后 20 年和 30 年时的 ESRD 累积风险分别为 2.2%和 7.0%。与 1965-1979 年诊断的患者相比，1995-2011 年诊断的患者发生 ESRD 的相对风险为 0.13（95%CI 0.08-0.22）。诊断时<5 岁的患者 ESRD 风险最低。从出生时估计 ESRD 的累积风险，诊断时年龄为 5-9 岁的患者风险最高。
在过去的五十年中，ESRD 的累积风险显著下降。这突显了现代糖尿病和糖尿病肾病治疗的重要性。
