Is the risk of end-stage kidney disease age-related in people with diabetes?

At present, there are still few studies on the long-term risk of ESKD in patients with type 2 diabetes, and in the literature interpreted by the previous editor, it was concluded that in patients with CKD combined with type 2 diabetes, poor glycemic control is associated with increased mortality, but not
with the risk of progression to ESKD.
So, does a long course give DN more time and the possibility of progressing to ESKD? This is the question explored in today's literature, so what is the author's conclusion?

This article, published in the journal Diabetes Care, assesses the effect of age at onset on the incidence of ESKD after the onset of type 2 diabetes and the long-term risk of end-stage kidney disease: A National Registry Study, published in the journal Diabetes Care
。

Methods: The study included 1,113,201 patients with type 2 diabetes mellitus (Figure 1) with a median age of onset of 58.
1 years
.
During the follow-up period of 7,839,075 people, there were 7,592 treated cases of ESKD and 192,005 deaths without ESKD
.
ESKD died from ESKD in 5671 cases that did not undergo renal replacement therapy RRT, and the vast majority of these cases were of an early age
of onset.

Figure 1 studies population characteristics

Analysis of the results:

The incidence of ESKD varies depending on the age at which diabetes develops, and the duration of treatment for diabetes also varies
.
Studies have found that the incidence of ESKD increases
with the duration of diabetes.
The study found that men had a higher incidence of ESKD than women, and that there was a greater
sex difference between those with diabetes who developed before age 40 and those who developed diabetes after age 40.
In the first 10 to 15 years of diabetes, the incidence of ESKD is higher
in people with an older age of onset.
However, the incidence of ESKD is higher in younger people with diabetes when diabetes lasts longer, and the higher the risk of developing ESKD at any given age, and the magnitude of the effect of diabetes duration is substantially greater than the effect of
age.
If untreated ESKD is included, people with an older age of onset still have a higher risk of ESKD during the first 20 years of diabetes, and after that, there is no clear difference in incidence by age category of onset (Figure 2).

Fig.
2 Incidence of ESKD after treatment in diabetic patients of different ages

Cumulative incidence of ESKD In the first 10-15 years of diabetes, young diabetics provide some protection
against ESKD for a certain duration of diabetes.
However, because diabetes persists for a long time, the cumulative incidence of ESKD is highest
in younger diabetic patients.
In younger diabetics, men have a higher risk of ESKD than women
.
During the first 20 years of diabetes, the cumulative incidence was higher in patients with an older age of onset of diabetes, after which the cumulative incidence became more similar across the categories of age of onset (Figure 3).

Figure 3 Cumulative incidence of ESKD for different duration of type 2 diabetes

Conclusions: Studies have observed that the incidence of ESKD in patients with type 2 diabetes increases with the duration of diabetes and age, leading to a complex association
between ESKD risk and age at onset of diabetes.
In the first 10-15 years of diabetes, people with an older age of onset of diabetes have a higher risk of developing ESKD, and the younger the age of onset, the longer the course of the disease, the higher
the risk.
However, because duration of diabetes is a major determinant of ESKD risk, and younger episodes of type 2 diabetes are more likely to survive to a longer duration of diabetes, younger episodes clearly confer a higher long-term risk
of ESKD.