Number Of New Diabetes-related Kidney Failure Patients More Than Doubles

[okarol]

Number Of New Diabetes-related Kidney Failure Patients More Than Doubles In 10 Years

10 Feb 2007
medicalnewstoday.com 

The number of newly diagnosed end-stage renal disease (kidney failure) patients with diabetes increased by 114% over 10 years, from 1,066 in 1995 to 2,139 in 2004, according to a new report released recently by the Canadian Institute for Health Information (CIHI). This increase in the presence of diabetes among new end-stage renal disease (ESRD) patients correlates with an increase in the incidence of diabetes in the Canadian population overall. ESRD refers to a condition in which the kidneys are permanently impaired and can no longer function to maintain life. For the first time, CIHI's annual report on end-stage organ disease, Treatment of End-Stage Organ Failure in Canada, 1995 to 2004, includes a special focus chapter on diabetes, a major risk factor in renal failure. Over the course of the decade, more than 17,000 kidney failure patients were diagnosed with diabetes.

"Diabetes is the fastest growing cause of end-stage renal disease," says Margaret Keresteci, CIHI's Manager of Clinical Registries. "In fact, diabetes is now a factor in more than 40% of all registered ESRD patients, up from 25% 10 years ago. It's important to note that the type of diabetes driving the increase is linked to obesity and lifestyle factors."

Type 2 diabetes plays dominant role

While the number of ESRD patients with type 1 diabetes (formerly known as insulin-dependent or juvenile diabetes) declined from 526 in 1995 to 303 in 2004 (down 42% in 10 years), the number of patients with type 2 diabetes (which is linked to obesity and lifestyle) more than tripled over the same period, from 540 to 1,836. Among kidney failure patients with type 2 diabetes, 30% were determined to be obese.

"The reduction of type 1 diabetes in kidney failure patients may be attributed to improved interventions and treatments over time," explains Keresteci. "What's remarkable is the surge in cases among patients with type 2 diabetes - a disease that is often preventable. Addressing ways to reduce the prevalence of this illness could help limit the devastating health consequences, including ESRD, associated with it."

More diabetics among seniors, Aboriginal people with kidney failure

In the period between 1995 and 2004, kidney failure patients aged 65 and older had the highest overall rate of diabetes, more than doubling from 124 per million in 1995 to 270 per million in 2004.

The greatest increase was seen in those over 75 years of age. For that group the rate of new kidney failure cases tripled between 1995 and 2004 (250 patients per million in 2004, up from 79 patients per million in 1995).

Also, in 2004, the Canadian Organ Replacement Register (CORR) reported that Aboriginal Canadians with ESRD had considerably higher rates (more than 2.5 times - 168 per million) of diabetes, compared to non-Aboriginal Canadians with ESRD (64 per million). The largest difference was seen in adults between the ages of 50 and 70.

Lower survival rate for dialysis patients with diabetes

Overall, the five-year survival rate for kidney failure patients on dialysis ranged from 20% for those 75 years of age and older to 89% for those younger than 18 years of age.

For patients on dialysis, CIHI's analysis found survival rates were worse for diabetic kidney failure patients than for non-diabetic patients. This was more pronounced among younger patients. Diabetic patients on dialysis between the ages of 18 and 65 had a 19% lower five-year survival rate when compared to those without diabetes. A smaller difference in long-term survival was seen between diabetic and non-diabetic kidney failure patients over 65, with a 6% difference between the two groups. Lower survival rate for diabetic kidney transplant recipients

Kidney transplant recipients with diabetes had a higher risk of mortality than those without it. Non-diabetic recipients had 93% five-year survival rates, compared to 82% for those with type 2 diabetes. Five-year survival was poorest among diabetic kidney recipients transplanted with deceased-donor organs (79%), while the survival rate for diabetic kidney recipients with living-donor organs was 88%.

Other report highlights

Additional highlights included in Treatment of End-Stage Organ Failure in Canada, 1995 to 2004:

Renal replacement therapy for ESRD patients (dialysis and renal transplant):

* At the end of 2004, there were 18,827 patients on dialysis and 12,099 living with a functioning kidney transplant, for a total of 30,924 Canadians with kidney failure registered in the CORR.

Liver transplantation:

* The number of patients waiting for a liver transplant grew steadily over the 10 years, (from 149 to 667), with an overall increase of 348%.

Heart transplantation:

* Between 1995 and 2004, 1,571 patients received a first heart transplant and 58 required a subsequent transplant.

Lung transplantation:

* The number of adult lung transplants increased by 64% between 1995 and 2004 (from 78 to 128).

Pancreas transplantation:

* Two-thirds of the 510 pancreas transplants performed in Canada between 1995 and 2004 were simultaneous pancreas-kidney transplants.

Organ donors:

* Between 1995 and 2004, there were 4,251 deceased donors. On a yearly basis the number of deceased donors dropped from 426 in 1995 to 417 in 2004.

* Between 1995 and 2004, there were 3,751 living donors (kidney and liver living donors only). On a yearly basis the number of living donors increased from 230 in 1995 to 476 in 2004.

Canadian Organ Replacement Register

Data are from the Canadian Organ Replacement Register (CORR), a national longitudinal database on end-stage organ failure managed by CIHI. CORR captures the level of activity and outcome of vital organ transplant and dialysis activities, following recipients with end-stage organ failure from their first treatment to their deaths. CORR became a registry of CIHI in 1995. About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

The report and the following are available from CIHI's website at http://www.cihi.ca.

Number of ESRD Patients, With and Without Diabetes, Canada, 1995 to 2004

Proportion of ESRD Patients (on Dialysis) With a Diagnosis of Diabetes, Canada, 1995 to 2004 (Figure 56 in the report)

Diabetes and Body Mass Index (BMI) in Newly Diagnosed ESRD Patients in Canada, 1995 to 2004 (Figure 62 in the report)

Unadjusted Five-Year Survival in ESRD Patients on Dialysis, With or Without Diabetes, by Age, 1995 to 1999 (Followed to 2004)

Unadjusted Five-Year Survival in Patients With Kidney Transplant, With or Without Diabetes, 1995 to 1999 (Followed to 2004)

For further information please go to:
Canadian Institute For Health Information
CIHI--Taking health information further

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=62613

[angela515]

I wonder why so many diabetes patients are having ESRD lately? My dad has it, and his dr closely monitors his kidneys when doing labs.. since nowadays they are more informed. Hmmm.

[kitkatz]

I think it is becasue diabetic patients are not caught soon enough with a diagnosis before kidney damage is done or they ar enot monitored closely enough int he beginning stages oi the disease. Also young people ar ebeing diagnosed with diabetes more and more and they often do not watch what they eat.  Besides when you are young you think you are immortal.  I think older people may not be followed because of age and end up with renal failure because noone thought to check on it.

[renal30yrs]

When I started dialysis there were comparatively fewer diabetics among us.  At my unit my shift right now the only patient who's cause of renal failure was not diabetes is me.

[jbeany]

A lack of nephrologists may be part of the problem.  My doc said that today's medical standards say anyone with an elevated creatine should see a nephrologist.  I think the number he said was something like 4 or 5 - at any rate, low enough that you wouldn't likely have any other symptoms of kidney failure.  You should be elvaluated at that point, and the neph should be making recommendations to prevent or slow further problems.  Where I'm from, there is only a single nephrologist to cover a tri-county area.  He is so busy with patients in actual kidney failure, that he doesn't have time to see patients when they are just beginning to show signs.  If he actually saw every patient up here with an elevated creatine, he'd not be able to sleep or eat.