The Association Between Age of Onset of Type 2 Diabetes and the Long-term Risk of End-Stage Kidney Disease: A National Registry Study

Abstract

The long-term risk of end-stage kidney disease (ESKD) in type 2 diabetes is poorly described, as is the effect that younger age of diabetes onset has on this risk. Therefore, we aimed to estimate the effect of age of onset on the cumulative incidence of ESKD from onset of type 2 diabetes. RESEARCH DESIGN AND METHODSThis study included 1,113,201 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2002 until 2013. The NDSS was linked to the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Death Index. RESULTSBetween 2002 and 2013, there were 7,592 incident cases of ESKD during 7,839,075 person-years of follow-up. In the first 10-15 years following the onset of diabetes, the incidence of ESKD was highest in those with an older age of onset of diabetes, whereas over longer durations of diabetes, the incidence of ESKD became higher in those with younger-onset diabetes. After 40 years of diabetes, the cumulative incidence of ESKD was 11.8% and 9.3% in those diagnosed with diabetes at ages 10-29 and 30-39 years, respectively. When death from ESKD without renal replacement therapy was included, the incidence of ESKD remained higher in older-onset diabetes for the initial 20 years, with no clear effect of age thereafter. CONCLUSIONSThe long-term risk of ESKD in type 2 diabetes is high, which disproportionately affects those with younger onset of diabetes because they are more likely to survive to longer diabetes durations.One of the most burdensome and costly complications of diabetes is end-stage kidney disease (ESKD) (1,2). People with diabetes are at considerably increased risk for the development of ESKD (3), and diabetic nephropathy (DN) is now the leading cause of ESKD, accounting for one-third of incident cases worldwide (4). Despite this significant burden, estimates of the long-term risk of ESKD for those with type 2 diabetes are scarce.

The Association Between Age at Diagnosis of Type 2 Diabetes and Albuminuria in Chinese Adults

“…Recent studies also demonstrated a higher risk of microvascular complications such as progressive chronic kidney disease [6] and retinopathy [24] in individuals with early-onset T2DM. However, studies have suggested that patients with early-onset T2DM were at increased risk of cardio-renal complications mainly driven by longer diabetes duration [4,7,10,25] . A recent study from Australia found that diabetes duration was the predominant determinant of end-stage kidney disease (ESKD) and the incidence of ESKD was higher at a given duration in those diagnosed later, which may be partly related to the increased risk at an advancing age [10] .…”

“…However, studies have suggested that patients with early-onset T2DM were at increased risk of cardio-renal complications mainly driven by longer diabetes duration [4,7,10,25] . A recent study from Australia found that diabetes duration was the predominant determinant of end-stage kidney disease (ESKD) and the incidence of ESKD was higher at a given duration in those diagnosed later, which may be partly related to the increased risk at an advancing age [10] . Because the actual age, age at diagnosis, and duration of diabetes are all important risk factors for diabetes complications such as chronic kidney disease and ESKD [20,26] , an appropriately designed study which takes into full consideration the confounding or impact from the actual age and diabetes duration is needed.…”

“…Previous studies have established close associations of age [2] and diabetes duration [3,4] with the risk of vascular complications in patients with diabetes. In addition, studies have suggested that a younger age at diagnosis was related to an increased risk of macrovascular and microvascular complications as well as death in diverse populations including Chinese patients [5][6][7][8][9][10] . However, few studies have fully accounted for the complex interplay between age at diagnosis and the actual age or diabetes duration, all of which are independently associated with vascular risks.…”

Projecting the Incidence of Type 2 Diabetes–Related End-Stage Kidney Disease Until 2040: A Comparison Between the Effects of Diabetes Prevention and the Effects of Diabetes Treatment

“…To estimate the ESKD incidence and all-cause mortality rates used for estimation of the lifetime risk of ESKD and projections of the incidence of ESKD-D, we used data derived from linkage of the National Diabetes Services Scheme (NDSS) to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and the Australian National Death Index (NDI) for 2002-2013, as previously described (1). Briefly, the NDSS was established by the Australian government in 1987 and includes 80-90% of people with diagnosed diabetes in Australia.…”

“…Incidence of ESKD and mortality rates among people without ESKD as a function of sex, age and duration of diabetes were predicted in order to estimate the lifetime risk of ESKD, as well as project the incidence of ESKD, using a framework previously described (1). Briefly, National Diabetes Services Scheme registrants were followed from 1 January 2002 or date of registration, if later, until onset of ESKD, death, or end of follow-up on 31 December 2013.…”