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

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

doi:10.1016/j.lanwpc.2021.100165

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

Lancet Reg Health West Pac. 2021 Jun 9:11:100165. doi: 10.1016/j.lanwpc.2021.100165. eCollection 2021 Jun.

Authors

Hongjiang Wu¹, Eric S H Lau¹, Aimin Yang^{1

2}, Cheuk-Chun Szeto¹, Ronald C W Ma^{1

2

3}, Alice P S Kong^{1

2

3}, Elaine Chow¹, Wing-Yee So^{1

4}, Juliana C N Chan^{1

2

3}, Andrea O Y Luk^{1

2

3}

Affiliations

¹ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
² Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
³ Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
⁴ Hong Kong Hospital Authority, Hong Kong Special Administrative Region, People's Republic of China.

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.