END-STAGE RENAL-DISEASE ATTRIBUTABLE TO DIABETES-MELLITUS

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 noninsulin-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 noninsulin-dependent diabetes) requires increased attention from laboratory and clinical researchers.