By Bruce Sylvester – Even with good clinical management of type 2 diabetes, the risk of premature death increases significantly with the onset of kidney disease, researchers reported on Jan. 24, 2014 in the Journal of the American Society of Nephrology (JASN).
“People with type 2 diabetes have many other risk factors for cardiovascular disease and mortality, so we expected that kidney disease would predict a part, but not a majority, of higher mortality associated with type 2 diabetes. To our surprise, we found that even in the medically complex patients with type 2 diabetes, kidney disease is a very powerful predictor of premature death,” said lead investigator Maryam Afkarian, MD, PhD, of the University of Washington in Seattle.
Since persons with diabetes also have an increased likelihood of premature death and an increased likelihood of ensuing kidney disease, the investigators sought to quantify how much kidney disease in diabetes contributes to the risk of early death.
They evaluated 10-year mortality rates in 15,046 US adults. They found kidney disease in 9.4% of non-diabetics and in 42.3% of type 2 diabetics.
Among subjects without diabetes or kidney disease, the 10-year mortality rate was 7.7%. Among subjects with type 2 diabetes but without kidney disease, mortality was 11.5%. Among subjects with type 2 diabetes and kidney disease, mortality was 31.1%.
Dr. Afkarian added, “First, among people with type 2 diabetes, the subgroup with kidney disease carries most of the mortality risk, so targeting intensive risk factor modification on this subgroup is likely to have the highest impact on overall mortality of people with diabetes. Secondly, preventing kidney disease may be a powerful way of reducing mortality in people with diabetes.”
The researchers noted that one in every 10 Americans (26 million) has diabetes, and a third or more of these diabetic persons will develop kidney disease. Likewise, 340 million persons worldwide have type 2 diabetes.