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Ann Intern Med. 1994 Dec 15;121(12):912-8.

End-stage renal disease attributable to diabetes mellitus.

Author information

1
Johns Hopkins University School of Hygiene and Public Health and School of Medicine, Baltimore, Maryland.

Abstract

OBJECTIVE:

To determine the proportion of end-stage renal disease associated with diabetes mellitus in a biracial population, using population-attributable risk estimates.

DESIGN:

Case-control study.

SETTING:

Population-based study in Maryland, Virginia, West Virginia, and Washington, D.C.

PARTICIPANTS:

716 newly treated patients with kidney failure aged 20 to 64 years and 361 age-matched controls.

MEASUREMENTS:

Self-reported history of diabetes mellitus, including type, duration, treatment, and complications.

RESULTS:

Persons with insulin-dependent diabetes (odds ratio, 33.7) and non-insulin-dependent diabetes (odds ratio, 7.0) were at greater risk for end-stage renal disease than were persons without diabetes. The odds ratio was only slightly increased for diabetes lasting less than 15 years, but the ratio increased more than 20-fold for diabetes lasting 15 years or more. The population-attributable risk for kidney failure was 21% for insulin-dependent diabetes and 21% for non-insulin-dependent diabetes (42% overall). A similar proportion of end-stage renal disease was attributed to diabetes in whites (44%) and in blacks (41%). Insulin-dependent diabetes had a relatively greater effect on the incidence of kidney failure in whites; in contrast, non-insulin-dependent diabetes had a relatively greater effect on kidney failure in blacks.

CONCLUSIONS:

Diabetes mellitus has a major effect on the incidence of end-stage renal disease in nonelderly adults. In black persons, diabetes may be responsible for a larger proportion of end-stage renal disease than is suggested by the use of clinical diagnoses of underlying renal disease made by patients' nephrologists. Prevention of end-stage renal disease associated with diabetes mellitus (both insulin-dependent and non-insulin-dependent diabetes) requires increased attention from laboratory and clinical researchers.

[Indexed for MEDLINE]

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