Trends in Incidence of ESKD in People With Type 1 and Type 2 Diabetes in Australia, 2002-2013

Abstract

Rationale & objective: The number of people with diabetes and end-stage kidney disease (ESKD) is increasing worldwide, but it is unknown whether this indicates an increasing risk for ESKD in people with diabetes. We examined temporal trends in the incidence of ESKD within the Australian population with diabetes from 2002 to 2013.

Study design: Follow-up study using a national health care services registry.

Setting & participants: Registrants with type 1 or type 2 diabetes in Australia's National Diabetes Services Scheme (NDSS).

Predictors: Age, sex, indigenous status, diabetes type, and calendar year.

Outcome: Incidence of ESKD (dialysis or kidney transplantation) or death ascertained using the Australian and New Zealand Dialysis and Transplant Registry and the Australian national death index.

Analytical approach: NDSS registrants were followed up from 2002 or date of registration until onset of ESKD, death, or December 31, 2013. The incidence of ESKD in type 1 diabetes was calculated only in those younger than 55 years.

Results: Among 1,375,877 registrants between 2002 and 2013, a total of 9,977 experienced incident ESKD, representing an overall incidence of ESKD in people with diabetes of 10.0 (95% CI, 9.8-10.2) per 10,000 person-years. Among those with type 1 diabetes, the age-standardized annual incidence was stable during the study period. Among those with type 2 diabetes, the incidence increased in nonindigenous people (annual percentage change, 2.2%; 95% CI, 0.4%-4.1%) with the greatest increases in those younger than 50 and those older than 80 years. No significant change over time was observed in indigenous people, although the adjusted incident rate ratio for indigenous versus nonindigenous was 4.03 (95% CI, 3.68-4.41).

Limitations: Lack of covariates such as comorbid conditions, medication use, measures of quality of care, and baseline kidney function.

Conclusions: The age-standardized annual incidence of ESKD increased in Australia from 2002 to 2013 for nonindigenous people with type 2 diabetes but was stable for people with type 1 diabetes. Efforts to prevent the development of ESKD, especially among indigenous Australians and those with early-onset type 2 diabetes, are warranted.

Keywords: ANZDATA; Australia; T2DM; Trends; diabetes; dialysis; disease registry; end-stage kidney disease (ESKD); health disparities; incidence; indigenous people; nondiabetic kidney disease; remote regions; renal replacement therapy (RRT); socioeconomic status; type 1 diabetes mellitus (T1DM).