Aims

Excess mortality is high in the setting of diabetes and end-stage kidney disease (ESKD), but the effects of ESKD beyond diabetes itself remains incompletely understood. We examined excess mortality in people with diabetes with versus without ESKD, and variation by age, sex and diabetes type.

Methods

This study included 63,599 people with type 1 (aged 20–69 years; 56% men) and 1,172,160 people with type 2 diabetes (aged 30+ years; 54% men), from the Australian National Diabetes Services Scheme. Initiation of renal replacement therapy and mortality outcomes were obtained via linkage to the Australia and New Zealand Dialysis and Transplant Registry and the National Death Index, respectively. Excess mortality was measured by calculating the mortality rate ratio (MRR) for people with versus without ESKD via indirect standardisation.

Results

A total of 9027 people developed ESKD during 8,601,522 person-years of follow-up. Among people with type 1 diabetes, the MRR was 34.9 (95%CI: 16.6–73.1) in men and 41.5 (20.8–83.1) in women aged 20–29 years and was 5.6 (4.5–7.0) and 7.4 (5.5–10.1) in men and women aged 60–69 years, respectively. In type 2 diabetes, MRRs were 16.6 (8.6–31.8) and 35.8 (17.0–75.2) at age 30–39 years and were 2.8 (2.6–3.1) and 3.6 (3.2–4.1) at age 80+ years in men and women, respectively. Excess cause-specific mortality was highest for peripheral artery disease, cardiac arrest, and infections, and lowest for cancer.

Conclusions

Among people with diabetes, excess mortality in ESKD is much higher at younger ages and is higher for women compared with men.