Impact of Type 2 Diabetes Mellitus on Age at Death in the Hemodialysis Population: An Analysis of Data from the Korean National Health Insurance and Statistical Information Service, 2006 to 2018

Abstract

Background/Objectives: Diabetic nephropathy is the leading cause of end-stage kidney disease (ESKD) worldwide. ESKD individuals with type 2 diabetes are known to have poor prognosis of survival. We aimed to investigate whether the recent mortality trends of ESKD individuals treated with hemodialysis with or without type 2 diabetes have changed in South Korea. Methods: We used a cohort of 3,394,502 deceased people from the Korean National Health Insurance Service claims database from 2006 to 2018. We requested the National Statistical Information Service database to link the records about their cause of death. We collected a total of 79,792 deaths among individuals with ESKD receiving hemodialysis, including 31,907 with type 2 diabetes and 47,885 without type 2 diabetes. Results: The mean age at death significantly increased over the study period among individuals with ESKD receiving hemodialysis, both with and without type 2 diabetes (p < 0.001). However, the mean age at death was consistently lower in those with type 2 diabetes compared to those without diabetes in both men and women. Type 2 diabetes was significantly associated with younger age at death in individuals undergoing hemodialysis (beta = -0.012, p < 0.0001). The age-standardized mortality rate remained higher in those with type 2 diabetes throughout the study period. Conclusions: This nationwide study revealed that Korean individuals with type 2 diabetes undergoing hemodialysis had a consistently lower age at death and higher age-standardized mortality than those without type 2 diabetes. Although the mean age at death increased in both groups, individuals undergoing hemodialysis with type 2 diabetes continued to show poorer survival outcomes. These findings highlight the need for targeted clinical approaches to improve survival in this high-risk population.