Results of the study, published in the Dec. 17 issue of the Journal of the American Medical Association, also show that diabetic men are four times as likely as their non-diabetic counterparts to develop ESRD attributed to such non-diabetic disorders as high blood pressure or kidney infection.
ESRD is the most advanced form of kidney failure, occurring when both kidneys gradually cease to function. Patients with ESRD require kidney dialysis or kidney transplants to survive.
"These data demonstrate that improvements in the prevention and control of diabetes, even for those with milder cases, could substantially reduce the health burden imposed by chronic renal failure," says Frederick L. Brancati, M.D., M.H.S., lead author of the study and an assistant professor of internal medicine and epidemiology at Hopkins.
The study, the first to show the relative risk of diabetics' developing ESRD, was supported by the National Institutes of Health. It was done in collaboration with researchers from the University of Minnesota in Minneapolis, and Northwestern University Medical School in Chicago.
Researchers studied the records of 332,544 men ages 35 to 57 who participated in the Multiple Risk Factor Intervention Trial (MRFIT), a national, multicenter trial conducted in the 1970s that aimed to reduce death rates from coronary artery disease by helping the men control high blood pressure, lower cholesterol and quit smoking.
ESRD risk was calculated by comparing these records with the names of men enrolled in the national Health Care Financing Administration's ESRD treatment registry between 1973 and 1990. Death from renal disease was assessed using data from the National Death Index and the Social Security Administration.
Over an average follow-up of 16 years, there were 136 cases of ESRD in 5,147 diabetic men and 678 cases in 327,397 non-diabetic men. Age-adjusted incidence of all-cause ESRD in the diabetic men was 199.8 per 100,000 person-years compared with 13.7 per 100,000 person-years in their non-diabetic counterparts. Diabetic men also were at higher risk for ESRD ascribed to causes other than diabetes.
The study's other authors were Paul K. Whelton, M.D., M.Sc., and Michael J. Klag, M.D., M.P.H., of Hopkins; Bryan L. Randall, M.S., and James D. Neaton, Ph.D., of the University of Minnesota; and Jeremiah Stamler, M.D., of Northwestern.
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Journal
JAMA