Renal Replacement Therapy in People With and Without Diabetes in Germany, 2010–2016: An Analysis of More Than 25 Million Inhabitants

Objective Epidemiological studies showed contradictory results regarding time trend of end stage renal disease (ESRD) in people with diabetes. This study aims to analyse the incidence of ESRD defined as chronic renal replacement therapy (RRT), to investigate time trends among people with and without diabetes in Germany and to examine if these patterns differed by age and sex.

Research design and methods The data was sourced from nationwide data pooled from two German branches of statutory health insurances covering approximately 25 million inhabitants. We estimated age- and sex-standardised incidence rates (IR) for chronic RRT among people with and without diabetes in 2010–2016, and the corresponding relative risks. Time trends were analysed using Poisson regression.

Results We identified 73,638 people with a first chronic RRT (male: 60.0%, diabetes: 60.6%, mean age: 71.3 years). The IR of chronic RRT among people with diabetes (114.1 per 100,000 person years: 95% confidence interval 110.0-117.2) was almost six times higher than among people without diabetes (19.6: 19.4-19.8). A consistent decline in IR was observed among people with diabetes (3% annual reduction, p < 0.0001) in both sexes and all age classes. In contrast, no consistent change of IR was identified in people without diabetes. Only among women aged under 40 (p=0.0003) and people aged 80 and over (p<0.0001) this IR decreased significantly.

Conclusion Incidence of chronic RRT remained significantly higher among people with diabetes. The IR decreased significantly in people with diabetes independent of age and sex. Time trends were inconsistent in people without diabetes.