Cumulative risk, age at onset, and sex-specific differences for developing end-stage renal disease in young patients with type 1 diabetes: a nationwide population-based cohort study

Anna Möllsten, Maria Svensson, Ingeborg Waernbaum, Yonas Berhan, Staffan Schön, Lennarth Nyström, Hans J Arnqvist, Gisela Dahlquist, Swedish Childhood Diabetes Study Group, Diabetes Incidence Study in Sweden, Swedish Renal Registry, Anna Möllsten, Maria Svensson, Ingeborg Waernbaum, Yonas Berhan, Staffan Schön, Lennarth Nyström, Hans J Arnqvist, Gisela Dahlquist, Swedish Childhood Diabetes Study Group, Diabetes Incidence Study in Sweden, Swedish Renal Registry

Abstract

Objective: This study aimed to estimate the current cumulative risk of end-stage renal disease (ESRD) due to diabetic nephropathy in a large, nationwide, population-based prospective type 1 diabetes cohort and specifically study the effects of sex and age at onset.

Research design and methods: In Sweden, all incident cases of type 1 diabetes aged 0-14 years and 15-34 years are recorded in validated research registers since 1977 and 1983, respectively. These registers were linked to the Swedish Renal Registry, which, since 1991, collects data on patients who receive active uremia treatment. Patients with > or =13 years duration of type 1 diabetes were included (n = 11,681).

Results: During a median time of follow-up of 20 years, 127 patients had developed ESRD due to diabetic nephropathy. The cumulative incidence at 30 years of type 1 diabetes duration was low, with a male predominance (4.1% [95% CI 3.1-5.3] vs. 2.5% [1.7-3.5]). In both male and female subjects, onset of type 1 diabetes before 10 years of age was associated with the lowest risk of developing ESRD. The highest risk of ESRD was found in male subjects diagnosed at age 20-34 years (hazard ratio 3.0 [95% CI 1.5-5.7]). In female subjects with onset at age 20-34 years, the risk was similar to patients' diagnosed before age 10 years.

Conclusions: The cumulative incidence of ESRD is exceptionally low in young type 1 diabetic patients in Sweden. There is a striking difference in risk for male compared with female patients. The different patterns of risk by age at onset and sex suggest a role for puberty and sex hormones.

Figures

FIG. 1.
FIG. 1.
Cumulative incidences of developing ESRD in male and female patients with type 1 diabetes onset at 0–9, 10–19, and 20–34 years. For patients with diabetes onset before 10 or 10–19 years of age, there is no significant difference between male and female subjects (P = 0.53 and P = 0.50), but with onset at 20–34 years of age there is a difference, although borderline significant, between male and female subjects in risk of developing ESRD (P = 0.05).
FIG. 2.
FIG. 2.
Cumulative incidences of developing ESRD in male and female patients according to age at onset of type 1 diabetes. When using age at onset 0–9 years as reference, the risk of ESRD is significantly increased with age at onset 10–19 years and 20–34 years for male subjects. For female subjects, the risk is significantly increased with age at onset 10–19 years but not 20–34 years.

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