Survival During Renal Replacement Therapy for Diabetic End-Stage Renal Disease in Pima Indians

Abstract

OBJECTIVE To examine survival in Pima Indians receiving renal replacement therapy for end-stage renal disease attributed to NIDDM. RESEARCH DESIGN AND METHODS Vital status through 1994 was determined for 136 diabetic Pima Indians from the Gila River Indian Community who began renal replacement therapy between 1973 and 1990. RESULTS Median survival from the onset of renal replacement therapy was 39 months (95% CI, 31–54), 31 months (95% CI, 11–48) in those who began treatment between 1973 and 1981, and 44 months (95% CI, 32–56) in those who began treatment between 1982 and 1990 (P = 0.020). During these periods, mean age at onset of treatment increased from 53.3 to 56.1 years (P = 0.166), and mean duration of diabetes at the onset of treatment increased from 16.5 to 20.2 years (P = 0.003). After adjustment for sex, duration of diabetes, initial dialysis type, and kidney transplantation by an age-stratified proportional-hazards analysis, the death rate after starting renal replacement therapy in the second half of the study was 0.54 times (95% CI, 0.33–0.88) that in the first half. If this analysis was restricted to those who survived at least 90 days of therapy, the difference between the time periods was diminished (death rate ratio = 0.76; 95% CI, 0.43–1.32). CONCLUSIONS Survival in Pima Indians receiving renal replacement therapy improved significantly over the study despite an increase in the average age and diabetes duration of those beginning dialysis. Much of the improvement in survival is attributable to a reduction in the number of deaths within the first 90 days of therapy. The median survival of 47 months in Pima Indians < 65 years old at the initiation of therapy is substantially longer than the 30 months reported in blacks and 16 months reported in whites of similar age with NIDDM.