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Clinical Epidemiology
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Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria

Carol Forsblom, Valma Harjutsalo, Lena M. Thorn, Johan Wadén, Nina Tolonen, Markku Saraheimo, Daniel Gordin, John L. Moran, Merlin C. Thomas, Per-Henrik Groop and on behalf of the FinnDiane Study Group
JASN March 2011, 22 (3) 537-544; DOI: https://doi.org/10.1681/ASN.2010020194
Carol Forsblom
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Valma Harjutsalo
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Lena M. Thorn
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Johan Wadén
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Nina Tolonen
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Markku Saraheimo
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Daniel Gordin
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John L. Moran
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Merlin C. Thomas
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Per-Henrik Groop
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Abstract

Patients with both type 1 diabetes and CKD have an increased risk of adverse outcomes. The competing risks of death and ESRD may confound the estimates of risk for each outcome. Here, we sought to determine the major predictors of the cumulative incidence of ESRD and pre-ESRD mortality in patients with type 1 diabetes and macroalbuminuria while incorporating the competing risk for the alternate outcome into a Fine-Gray competing-risks analysis. We followed 592 patients with macroalbuminuria for a median of 9.9 years. During this time, 56 (9.5%) patients died and 210 (35.5%) patients developed ESRD. Predictors of incident ESRD, taking baseline renal function and the competing risk for death into account, included an elevated HbA1c, elevated LDL cholesterol, male sex, weight-adjusted insulin dose, and a shorter duration of diabetes. By contrast, predictors of pre-ESRD death, taking baseline renal function and the competing risk for ESRD into account, included only age, the presence of established macrovascular disease, and elevated cholesterol levels. This competing-risks approach has potential to highlight the appropriate targets and strategies for preventing premature mortality in patients with type 1 diabetes.

  • Copyright © 2011 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 22 (3)
Journal of the American Society of Nephrology
Vol. 22, Issue 3
1 Mar 2011
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Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria
Carol Forsblom, Valma Harjutsalo, Lena M. Thorn, Johan Wadén, Nina Tolonen, Markku Saraheimo, Daniel Gordin, John L. Moran, Merlin C. Thomas, Per-Henrik Groop, on behalf of the FinnDiane Study Group
JASN Mar 2011, 22 (3) 537-544; DOI: 10.1681/ASN.2010020194

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Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria
Carol Forsblom, Valma Harjutsalo, Lena M. Thorn, Johan Wadén, Nina Tolonen, Markku Saraheimo, Daniel Gordin, John L. Moran, Merlin C. Thomas, Per-Henrik Groop, on behalf of the FinnDiane Study Group
JASN Mar 2011, 22 (3) 537-544; DOI: 10.1681/ASN.2010020194
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  • Kidney Injury Molecule-1 and the Loss of Kidney Function in Diabetic Nephropathy: A Likely Causal Link in Patients With Type 1 Diabetes
  • Improved Glycemic Control and Risk of ESRD in Patients with Type 1 Diabetes and Proteinuria
  • Renal Outcomes in Patients with Type 1 Diabetes and Macroalbuminuria
  • Osteopontin Is a Strong Predictor of Incipient Diabetic Nephropathy, Cardiovascular Disease, and All-Cause Mortality in Patients With Type 1 Diabetes
  • Improved Survival and Renal Prognosis of Patients With Type 2 Diabetes and Nephropathy With Improved Control of Risk Factors
  • Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes mellitus: a competing-risks analysis
  • Risk for End-Stage Renal Disease Over 25 Years in the Population-Based WESDR Cohort
  • Urinary Liver-Type Fatty Acid-Binding Protein and Progression of Diabetic Nephropathy in Type 1 Diabetes
  • Serum Concentration of Cystatin C and Risk of End-Stage Renal Disease in Diabetes
  • Vascular Disease, ESRD, and Death: Interpreting Competing Risk Analyses
  • Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection
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