RISK OF END-STAGE RENAL-DISEASE IN DIABETES-MELLITUS - A PROSPECTIVE COHORT STUDY OF MEN SCREENED FOR MRFIT

Context.-Diabetes is a frequent cause of end-stage renal disease (ESRD ). However, the degree of risk is uncertain. Objective.-To determine t he relative risk (RR) of ESRD related to diabetes in the United States . Design.-Nonconcurrent prospective cohort study. Participants.-A tota l of 332 544 men aged 35 to 57 years from 18 US cities screened in 197 3 to 1975 for participation in the Multiple Risk Factor Intervention T rial (MRFIT). Main Exposure.-Diabetes mellitus defined by self-reporte d use of medication for diabetes at baseline. Main Outcome.-Incident E SRD through 1990 assessed from a national ESRD registry and by surveil lance for death from renal disease. Results.-Over an average follow-up of 16 years, there were 136 cases of ESRD in 5147 diabetic men and 67 8 cases in 327 397 nondiabetic men. Age-adjusted incidence of all-caus e ESRD in the diabetic men was 199.8 per 100 000 person-years compared with 13.7 per 100 000 person years in their nondiabetic counterparts (RR, 12.7; 95% confidence interval [CI], 10.5-15.4). Diabetic men were also at higher risk for ESRD ascribed to causes other than diabetes ( RR=4.3; 95% CI, 3.2-5.9). With simultaneous adjustment for age, ethnic ity, income, blood pressure, serum cholesterol level, and history of m yocardial infarction, diabetic men remained at higher risk for ail-cau se ESRD (RR, 9.0; 95% CI, 7.4-11.0), ESRD ascribed to diabetes (RR, 92 .3; 95% CI, 64.6-131.9), and ESRD ascribed to nondiabetic causes (RR, 3.0; 95% CI, 2.2-4.1). Conclusions.-Diabetes mellitus is a strong inde pendent risk factor for ESRD, even for ESRD ascribed to causes other t han diabetes. Improvements in the prevention and control of diabetes s hould produce substantial reductions in ESRD incidence.