Risk of End-stage Renal Disease in Diabetes Mellitus

Abstract

<h3>Context.</h3> —Diabetes is a frequent cause of end-stage renal disease (ESRD). However, the degree of risk is uncertain. <h3>Objective.</h3> —To determine the relative risk (RR) of ESRD related to diabetes in the United States. <h3>Design.</h3> —Nonconcurrent prospective cohort study. <h3>Participants.</h3> —A total of 332 544 men aged 35 to 57 years from 18 US cities screened in 1973 to 1975 for participation in the Multiple Risk Factor Intervention Trial (MRFIT). <h3>Main Exposure.</h3> —Diabetes mellitus defined by self-reported use of medication for diabetes at baseline. <h3>Main Outcome.</h3> —Incident ESRD through 1990 assessed from a national ESRD registry and by surveillance for death from renal disease. <h3>Results.</h3> —Over an average follow-up of 16 years, there were 136 cases of ESRD in 5147 diabetic men and 678 cases in 327 397 nondiabetic men. Age-adjusted incidence of all-cause ESRD in the diabetic men was 199.8 per 100 000 person-years compared with 13.7 per 100 000 person years in their nondiabetic counterparts (RR, 12.7; 95% confidence interval [Cl], 10.5-15.4). Diabetic men were also at higher risk for ESRD ascribed to causes other than diabetes (RR=4.3; 95% Cl, 3.2-5.9). With simultaneous adjustment for age, ethnicity, income, blood pressure, serum cholesterol level, and history of myocardial infarction, diabetic men remained at higher risk for all-cause ESRD (RR, 9.0; 95% Cl, 7.4-11.0), ESRD ascribed to diabetes (RR, 92.3; 95% Cl, 64.6-131.9), and ESRD ascribed to nondiabetic causes (RR, 3.0; 95% Cl, 2.2-4.1). <h3>Conclusions.</h3> —Diabetes mellitus is a strong independent risk factor for ESRD, even for ESRD ascribed to causes other than diabetes. Improvements in the prevention and control of diabetes should produce substantial reductions in ESRD incidence.