Improved survival rate in patients with diabetes and end-stage renal disease in Denmark

Sørensen, Vibeke Rømming; Mathiesen, Elisabeth R.; Heaf, James; Feldt‐Rasmussen, Bo

doi:10.1007/s00125-007-0612-5

Cited by 46 publications

(28 citation statements)

References 28 publications

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“…In Denmark, 22% of patients with ESRD have diabetes (12). The first clinical sign is microalbuminuria, defined as a urinary albumin excretion of 30-300 mg/24 h, corresponding to a spot urine albumin/ creatinine ratio of 30-300 mg/mg.…”

Section: Pathophysiology and Treatment Of Diabetic Nephropathymentioning

confidence: 99%

Obstetric Nephrology

Mathiesen

Ringholm

Feldt‐Rasmussen

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryThis review highlights factors of importance for the clinical care of pregnant women with pregestational diabetes and microalbuminuria or diabetic nephropathy with particular focus on the role of intensive antihypertensive treatment during pregnancy. Most information in the literature comes from women with type 1 diabetes and diabetic nephropathy, but this is probably also valid for women with type 2 diabetes. Careful counseling of women with diabetic nephropathy before pregnancy with estimation of the risk for the mother and fetus is important. Pregnancy does not result in worsening of kidney function in women with diabetic nephropathy and normal serum creatinine, but pregnancy complications such as pre-eclampsia and preterm delivery are common. Intensive metabolic control before and during pregnancy, low-dose aspirin from 12 gestational weeks onward, and intensive antihypertensive treatment are important. Methyldopa, labetalol, and nifedipine are regarded safe in pregnancy, whereas angiotensin converting enzyme inhibitors, AngII antagonists, or statins should be paused before pregnancy. Case series and pathophysiological studies support the use of a stringent goal for BP and albumin excretion in pregnant women with diabetic nephropathy. Screening for diabetic retinopathy before and during pregnancy is mandatory and laser treatment should be performed if indicated. Pregnancy outcome in women with diabetic nephropathy has improved considerably with a take-home-baby rate of approximately 95%. Further research on the benefits and risks of intensive antihypertensive treatment in this population is needed.

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Section: Pathophysiology and Treatment Of Diabetic Nephropathymentioning

confidence: 99%

Obstetric Nephrology

Mathiesen

Ringholm

Feldt‐Rasmussen

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Although the survival of diabetic patients treated with dialysis in Denmark has improved during the past 15 years [4], a significant number of diabetic patients treated with chronic maintenance dialysis still suffer from one or more diabetic complications besides the kidney failure and have increased cardiovascular morbidity and mortality rates [5,6].…”

Section: Introductionmentioning

confidence: 99%

Diabetic patients treated with dialysis: complications and quality of life

et al. 2007

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Aims/hypothesis The aim of this study was to describe the prevalence of complications, health-related quality of life (HRQOL) and the influence of beliefs about control over health in diabetic dialysis patients. Methods Of 53 eligible diabetic patients on chronic dialysis during January 2004 in our clinic, 38 (76%) completed a kidney-specific (Kidney Disease Quality of Life) and a generic (SF-36) questionnaire and were characterised in terms of cardiovascular diseases and diabetic complications. Matched groups of non-diabetic dialysis patients (n= 40) and diabetic patients with a long duration of diabetes and normal kidney function (n=38) served as controls. Generic HRQOL was compared with matched data from a survey on the Danish general population (n=2248).

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“…Nevertheless, a study in Denmark showed that the survival rate of patients with ESRD who had type 2 diabetes has improved during the 1990 -2005 period (8). Available studies on patients with ESRD who have type 1 and type 2 diabetes have shortcomings because analyses were limited to patients with diabetic nephropathy (6 -7), did not differentiate the two types of diabetes (9), were short-term (10), or were based on single-center experiences (11).…”

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confidence: 99%

Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991–2005)

2007

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OBJECTIVE -We aimed to update the epidemiology of type 1 and type 2 diabetic patients among the incident end-stage renal disease (ESRD) population in Australia and New Zealand (ANZ) and to determine whether outcome is worse for diabetic women, as described in the general population.RESEARCH DESIGNS AND METHODS -All resident adults of ANZ who began renal replacement therapy (RRT) from 1 April 1991 to 31 December 2005 were included using data from the ANZ Dialysis and Transplant Registry. Incidence rates, RRT, and survival were analyzed. Risk factors for death were assessed using Cox regression.RESULTS -The study included 1,284 type 1 diabetic (4.5%), 8,560 type 2 diabetic (30.0%), and 18,704 nondiabetic (65.5%) patients. The incidence rate of ESRD with type 2 diabetes increased markedly over time (ϩ10.2% annually, P Ͻ 0.0001). In patients aged Ͻ70 years, rates of renal transplantation in type 1 diabetic, type 2 diabetic, and nondiabetic patients were 41.8, 6.5 (P Ͻ 0.0001 vs. other patients), and 40.9% (P ϭ 0.56 vs. type 1 diabetic patients), respectively. Compared with nondiabetic patients, the adjusted hazard ratio (HR) for death was 1.64 (P Ͻ 0.0001) in type 1 diabetes and 1.13 (P Ͻ 0.0001) in type 2 diabetes. Survival rates per 5-year period improved by 6% in type 1 diabetic patients (P ϭ 0.36), by 9% in type 2 diabetic patients (P Ͻ 0.0001), and by 5% in nondiabetic patients (P ϭ 0.001). In type 2 diabetic patients aged Ն60 years, the adjusted HR for death in women versus men was 1.19 (P ϭ 0.0003).CONCLUSIONS -The incidence of ESRD with type 2 diabetes increased markedly. Despite high access to renal transplants, type 1 diabetic patients had a poor prognosis after starting RRT. Survival improved significantly in type 2 diabetic patients during the study period. Older type 2 diabetic women had a worse prognosis than older type 2 diabetic men. Diabetes Care 30:3070-3076, 2007D iabetes is associated with high mortality in the general population (1,2). Worse prognosis has also been reported in diabetic women compared with diabetic men (3,4). End-stage renal disease (ESRD) in patients with type 2 diabetes has increased dramatically worldwide during the last few decades, and diabetes is associated with worse survival among patients undergoing dialysis (5-7).Nevertheless, a study in Denmark showed that the survival rate of patients with ESRD who had type 2 diabetes has improved during the 1990 -2005 period (8). Available studies on patients with ESRD who have type 1 and type 2 diabetes have shortcomings because analyses were limited to patients with diabetic nephropathy (6 -7), did not differentiate the two types of diabetes (9), were short-term (10), or were based on single-center experiences (11).The aim of the present study was to examine the epidemiology and long-term survival of patients with incident ESRD by diabetes status (type 1 diabetes, type 2 diabetes, and no diabetes) in Australia and New Zealand (ANZ) and to determine whether outcomes were different between the sexes among patients with diabetes. RESE...

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Improved survival rate in patients with diabetes and end-stage renal disease in Denmark

Cited by 46 publications

References 28 publications

Obstetric Nephrology

Obstetric Nephrology

Diabetic patients treated with dialysis: complications and quality of life

Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991–2005)

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