Low Incidence of End-Stage Renal Disease in Childhood-Onset Type 1 Diabetes Followed for Up to 42 Years

Abstract

OBJECTIVE 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. RESEARCH DESIGN AND METHODS 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. RESULTS 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). CONCLUSIONS 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.