QJM Advance Access published online on August 6, 2007
QJM, doi:10.1093/qjmed/hcm062
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Patients with diabetic nephropathy on renal replacement therapy in England and Wales
From the 1Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, 2Renal Unit, Nottingham City Hospital, Nottingham, 3UK Renal Registry and 4Renal Unit, Southmead Hospital, Bristol, and 5Applied Epidemiology Group, University of Southampton, Southampton General Hospital, Southampton, UK
Address correspondence to Dr D. Nitsch, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. email: dorothea.nitsch{at}lshtm.ac.uk
Received 1 March 2007 and in revised form 30 April 2007
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Abstract |
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Background: The incidence of patients with diabetic nephropathy (DN) who start renal replacement therapy (RRT) is increasing.
Aim: To describe the characteristics and survival of patients with DN starting RRT in the UK
Design: Retrospective cohort study.
Methods: We analysed data for incident patients on RRT in centres participating in the Renal Association UK Renal Registry (UKRR), 1997 –2004, comparing DN vs. non-DN patients with regard to survival, social deprivation, ethnicity, gender, and age, using Cox regression models.
Results: DN was the most common renal disease (19%) in the 20 532 patients starting RRT. The majority of patients with DN (77%) were Caucasian. Within the Caucasian population, DN patients were more likely to be from a socially deprived area (p < 0.0001). About 20% were referred <3 months before starting RRT. The difference in crude survival was greatest in younger patients (5-year survival was 56% (DN) vs. 85% (non-DN) in patients aged 18–54 years, and 17% (DN) vs. 28% (non-DN) in patients aged 
65 years). Despite adjusting for gender, age, treatment modality, social deprivation, referral and co-morbidities, the long-term prognosis for DN patients aged 18–54 years was worse (adjusted hazard ratio 2.13, 95%CI 1.23–3.67) than for older age groups.
Discussion: Patients with DN starting RRT are more likely to come from socially deprived areas. Relative risk of death is greatest in working-age DN patients and is not fully explained by recorded co-morbidity. This emphasizes the need for focused diabetes care in poorer areas, and assessment of quality of care of diabetic patients on RRT.