OBJECTIVE To investigate how risk of end-stage renal disease (ESRD) among patients with type 1 diabetes has changed over time and further how the risk is affected by age, sex, and time period of diagnosis of diabetes.

RESEARCH DESIGN AND METHODS A cohort including all patients <30 years old diagnosed with type 1 diabetes in Finland in 1965–2011 was followed until start of renal replacement therapy, death, or end of follow-up at the end of 2013. Altogether, 29,906 patients were included. The main outcome was cumulative risk of ESRD, accounting for death as a competing risk.

RESULTS The patients were followed up for a median of 20 years. During 616,403 patient-years, 1,543 ESRD cases and 4,185 deaths were recorded. The cumulative risk of ESRD was 2.2% after 20 years and 7.0% after 30 years from the diabetes diagnosis. The relative risk of ESRD was 0.13 (95% CI 0.08–0.22) among patients diagnosed in 1995–2011 compared with those diagnosed in 1965–1979. Patients <5 years old at the time of diagnosis had the lowest risk of ESRD after diagnosis. With the cumulative risk of ESRD estimated from time of birth, the patients aged 5–9 years at diabetes diagnosis were at highest risk.

CONCLUSIONS The cumulative risk of ESRD has decreased markedly during the past five decades. This highlights the importance of modern treatment of diabetes and diabetic nephropathy.

目的探讨1型糖尿病患者终末期肾脏疾病（ESRD）的风险如何随时间变化，以及该风险如何受到年龄，性别和糖尿病诊断时间的影响。

研究设计和方法追踪包括1965年至2011年在芬兰被诊断为1型糖尿病的所有30岁以下患者的队列，直到2013年底开始肾脏替代治疗，死亡或随访结束。总计29,906包括患者。主要结果是ESRD的累积风险，将死亡视为竞争风险。

结果对患者进行了平均20年的随访。在616,403名患者年中，记录了1,543例ESRD病例和4,185例死亡。从糖尿病诊断开始，ESRD的累积风险在20年后为2.2％，在30年后为7.0％。1995-2011年诊断出的患者与1965-1979年诊断出的患者相比，ESRD的相对风险为0.13（95％CI 0.08-0.22）。诊断时<5岁的患者在诊断后发生ESR​​D的风险最低。从出生时开始估算ESRD的累积风险，诊断为糖尿病的5-9岁患者处于最高风险。

结论在过去的50年中，ESRD的累积风险已显着降低。这突出了现代治疗糖尿病和糖尿病性肾病的重要性。