Visual Abstract

Background: The number of people with diabetes-related end-stage renal disease (ESRD-DM) has doubled in the last two decades. We examined changes in excess mortality for people with ESRD-DM from 2002 onwards in the US and Australia.

Methods: We included all adults (ages 20-84) receiving renal replacement therapy for ESRD-DM in the US (n = 1,178,860 from the United States Renal Data System, 2002-2017) and Australia (n = 10,380 from the Australia and New Zealand Dialysis and Transplant Registry, 2002-2013). Annual standardized mortality ratios (SMRs) were stratified by age, sex, race (US only), and treatment modality. Trends were assessed using Join point regression and annual percent change (APC) reported.

Results: Overall, the SMR for ESRD-DM decreased from 2006-2013 in the US (from 11.4 to 9.5; APC: -2.5) and 2002-2013 in Australia (from 11.6 to 9.3; APC: -3.3). Differences by subgroup were noted, see Figure 1.

Conclusions: Excess mortality for people with ESRD-DM has decreased in the US and Australia, but progress has stalled since 2013 in the US (comparative Australian data not available). Further, excess mortality remains more than nine times higher in ESRD-DM vs. the general population, with important variations by subgroups. Given the increasing burden of diabetes in the population, a focus on reducing excess mortality risk in the ESRD-DM population is needed.


J. L. Harding: None. J. I. Morton: None. J. E. Shaw: Advisory Panel; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Pfizer Inc., Research Support; Self; AstraZeneca, Speaker’s Bureau; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk. D. J. Magliano: None.

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