A Shankar1, R Klein, B E K Klein, S E Moss. 1. Division of Epidemiology, Department of Community, Occupational, and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. ashankar@nus.edu.sg
Abstract
CONTEXT: The incidence of recently defined outcome of chronic kidney disease (CKD) has not been widely reported in type 1 diabetes. OBJECTIVE: To examine the prospective association between baseline glycosylated hemoglobin levels and the 16-year incidence of CKD and end-stage renal disease (ESRD) in type 1 diabetes. DESIGN: Prospective cohort study of type 1 diabetes individuals. SETTING: Community based in southwestern Wisconsin. PARTICIPANTS: 547 younger-onset type 1 diabetes individuals who were free of CKD at baseline (1984-86). MAIN OUTCOME MEASURES: Development of CKD (defined as estimated glomerular filtration rate<60 ml/min/1.73 m(2) or ESRD [history of dialysis or renal transplantation]) over 16-year follow-up period, among individuals free of CKD at baseline. Alternate outcome was 16-year incident ESRD. RESULTS: After 16 years of follow-up, there were 158 cases of CKD and 37 cases of ESRD in our cohort. The 16-year cumulative incidence of CKD was 31.7 percent. Elevated glycosylated hemoglobin levels were associated with incident CKD and ESRD in separate models. Multivariable odds ratio (OR) [95% confidence intervals (CI)] comparing the highest quartile of glycosylated hemoglobin (11-15.3%) to the lowest quartile (6-8.6%) was 6.44 (3.61-11.51), p-trend<0.0001 for incident CKD and 21.87 (2.84-168.39), p-trend<0.0001 for ESRD. CONCLUSIONS: Higher baseline glycosylated hemoglobin levels are independently associated with incident CKD and ESRD, among individuals with type 1 diabetes.
CONTEXT: The incidence of recently defined outcome of chronic kidney disease (CKD) has not been widely reported in type 1 diabetes. OBJECTIVE: To examine the prospective association between baseline glycosylated hemoglobin levels and the 16-year incidence of CKD and end-stage renal disease (ESRD) in type 1 diabetes. DESIGN: Prospective cohort study of type 1 diabetes individuals. SETTING: Community based in southwestern Wisconsin. PARTICIPANTS: 547 younger-onset type 1 diabetes individuals who were free of CKD at baseline (1984-86). MAIN OUTCOME MEASURES: Development of CKD (defined as estimated glomerular filtration rate<60 ml/min/1.73 m(2) or ESRD [history of dialysis or renal transplantation]) over 16-year follow-up period, among individuals free of CKD at baseline. Alternate outcome was 16-year incident ESRD. RESULTS: After 16 years of follow-up, there were 158 cases of CKD and 37 cases of ESRD in our cohort. The 16-year cumulative incidence of CKD was 31.7 percent. Elevated glycosylated hemoglobin levels were associated with incident CKD and ESRD in separate models. Multivariable odds ratio (OR) [95% confidence intervals (CI)] comparing the highest quartile of glycosylated hemoglobin (11-15.3%) to the lowest quartile (6-8.6%) was 6.44 (3.61-11.51), p-trend<0.0001 for incident CKD and 21.87 (2.84-168.39), p-trend<0.0001 for ESRD. CONCLUSIONS: Higher baseline glycosylated hemoglobin levels are independently associated with incident CKD and ESRD, among individuals with type 1 diabetes.
Authors: Charumathi Sabanayagam; Anoop Shankar; Barbara E K Klein; Kristine E Lee; Paul Muntner; F Javier Nieto; Michael Y Tsai; Karen J Cruickshanks; Carla R Schubert; Peter C Brazy; Josef Coresh; Ronald Klein Journal: Am J Kidney Dis Date: 2011-05 Impact factor: 8.860
Authors: A Esteghamati; A Arefzadeh; A Zandieh; M Salehi Sadaghiani; S Noshad; M Nakhjavani Journal: J Endocrinol Invest Date: 2013 Jul-Aug Impact factor: 4.256
Authors: Tamara J Lecaire; Barbara E K Klein; Kerri P Howard; Kristine E Lee; Ronald Klein Journal: Diabetes Care Date: 2013-09-11 Impact factor: 19.112