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. 2021 Jun 9:11:100165.
doi: 10.1016/j.lanwpc.2021.100165. eCollection 2021 Jun.

Trends in kidney failure and kidney replacement therapy in people with diabetes in Hong Kong, 2002-2015: A retrospective cohort study

Hongjiang Wu  1 , Eric S H Lau  1 , Aimin Yang  1   2 , Cheuk-Chun Szeto  1 , Ronald C W Ma  1   2   3 , Alice P S Kong  1   2   3 , Elaine Chow  1 , Wing-Yee So  1   4 , Juliana C N Chan  1   2   3 , Andrea O Y Luk  1   2   3
Affiliations

Trends in kidney failure and kidney replacement therapy in people with diabetes in Hong Kong, 2002-2015: A retrospective cohort study

Hongjiang Wu et al. Lancet Reg Health West Pac. .

Abstract

Background: There are limited population-wide trend data on kidney failure and kidney replacement therapy (KRT) in people with diabetes. We conducted a retrospective cohort study to report incidence trends of kidney failure and KRT and related mortality in people with diabetes in Hong Kong between 2002 and 2015.

Methods: We used territory-wide electronic medical records including laboratory, diagnostic and procedural data to identify people with kidney failure and KRT. We used Joinpoint regression models to estimate the average annual percent change (AAPC) of kidney failure and KRT incidence for entire study period, and annual percent change (APC) for each linear trend segment, along with 1-year and 5-year mortality rates.

Findings: During 4.9 million person-years of follow-up of 712,222 people with diabetes, 31,425 developed kidney failure, among whom 23.0% (n=7,233) received KRT. The incidence of kidney failure declined by 46.8% from 2002 to 2007 (APC: -11.6, 95% CI: -16.3, -6.7), then flattened from 2007 to 2015 (APC: -0.9, 95% CI: -3.1, 1.3). The incidence of KRT remained constant (AAPC: -1.6, 95% CI: -4.4, 1.2). The 1-year mortality rates declined statistically significantly after both kidney failure and KRT. The 5-year mortality rates declined after kidney failure but the decline was not statistically significant after KRT.

Interpretation: The findings of our study highlight the importance of developing new strategies to prevent a looming epidemic of kidney failure in people with diabetes in Hong Kong.

Funding: Asia Diabetes Foundation.

Keywords: AAPC, Average annual percent change; APC, Annual percent change; EMR, Electronic medical record; HA, Hospital Authority; HD, Hemodialysis; HKDSD, Hong Kong Diabetes Surveillance Database; KRT, Kidney replacement therapy; PD, Peritoneal dialysis; RAAS, Renin-angiotensin-aldosterone system; RAMP-DM, Risk Assessment and Management Programme-Diabetes Mellitus; diabetes; incidence; kidney failure; kidney replacement therapy; mortality; trend.

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Conflict of interest statement

Dr. Ma reports grants from AstraZeneca, Bayer, Pfizer, Novo Nordisk, Sanofi, personal fees from Worldwide Initiative for Diabetes Education (WorldWIDE Diabetes), Speaker honorarium from Boehringer Ingelheim, outside the submitted work; receives support from the Hong Kong Government Innovation and Technology Commission and its Technology Start-up Support Scheme for Universities (TSSSU), as co-founded a technology start-up which provides genetic testing for diabetes and diabetes complications. No income or renumeration received from the company. Dr. Chan reports grants from Astra Zeneca, Lilly, Hua Medicine, Lee Powder; grants and personal fees from Bayer, MSD, Merck, and Sanofi; act as CEO in Asia Diabetes Foundation and founding director in GemVCare, outside the submitted work; In addition, Dr. Chan has a patent Genetic markers for DKD issued. Dr. Luk reports non-financial support from Astra Zeneca, MSD, and Boehringer Inglheim; grants from Sanofi Hong Kong Limited and Amgan, acts as principal investigator of sponsored studies from MSD, Bayer, Roche, and Lee's Pharmaceutical, outside the submitted work.

Figures

Fig 1
Fig 1
Flowchart of participants selection in the Hong Kong Diabetes Surveillance Database between 2002 and 2015.
Fig 2
Fig 2
Trends in standardised incidence rates of kidney failure (a and b) and KRT (c and d) in people with diabetes in Hong Kong between 2002 and 2015, stratified by sex (a and c) and age (b and d). Dots are observed rates and solid lines are modelled rates from Joinpoint regression models.
Fig 3
Fig 3
Trends in standardised 1-year mortality rates after kidney failure (a and b) and KRT (c and d) in people with diabetes in Hong Kong between 2002 and 2015, stratified by sex (a and c) and age (b and d). Dots are observed rates and solid lines are modelled rates from Joinpoint regression models. Joinpoint regression analysis for 1-year mortality rates after KRT was not performed for people aged 20-44 years because no people aged 20-44 years died within one year after KRT in 2009.
Fig 4
Fig 4
Trends in standardised 5-year mortality rates after kidney failure (a and b) and KRT (c and d) in people with diabetes in Hong Kong between 2002 and 2011, stratified by sex (a and c) and age (b and d). Dots are observed rates and solid lines are modelled rates from Joinpoint regression models.
See this image and copyright information in PMC

References

    1. de Boer I.H., Caramori M.L., Chan J.C.N. Executive summary of the 2020 KDIGO Diabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment. Kidney Int. 2020;98(4):839–848. - PubMed
    1. Afkarian M., Sachs M.C., Kestenbaum B. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013;24(2):302–308. - PMC - PubMed
    1. Yeh H., Lin C., Li Y.R. Temporal trends of incident diabetes mellitus and subsequent outcomes in patients receiving kidney transplantation: a national cohort study in Taiwan. Diabetol Metab Syndr. 2020;12:34. - PMC - PubMed
    1. United States Renal Data System. 2019 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2019.
    1. ANZDATA Registry . Adelaide; Australia: 2019. Australia and New Zealand Dialysis and Transplant Registry. ANZDATA 42nd Annual Report 2019.