Janet B McGill1, Mengdi Wu2, Rodica Pop-Busui3, Kara Mizokami-Stout3, William V Tamborlane4, Grazia Aleppo5, Rose A Gubitosi-Klug6, Michael J Haller7, Steven M Willi8, Nicole C Foster9, Chelsea Zimmerman7, Ingrid Libman10, Sarit Polsky11, Michael R Rickels12. 1. Washington University School of Medicine, St. Louis, MO, United States of America. 2. Jaeb Center for Health Research, Tampa, FL, United States of America. 3. University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, MI, United States of America. 4. Yale University School of Medicine, New Haven, CT, United States of America. 5. Northwestern University, Chicago, IL, United States of America. 6. Univeristy Hospitals of Cleveland, Cleveland, OH, United States of America. 7. University of Florida, Gainesville, FL, United States of America. 8. Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; University of Pennsylvania Perelman School of Medicine, Rodebaugh Diabetes Center, Philadelphia, PA, United States of America. 9. Jaeb Center for Health Research, Tampa, FL, United States of America. Electronic address: t1dstats3@jaeb.org. 10. UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America. 11. Barbara Davis Center for Diabetes, Aurora, CO, United States of America. 12. University of Pennsylvania Perelman School of Medicine, Rodebaugh Diabetes Center, Philadelphia, PA, United States of America.
Abstract
AIMS: Diabetic kidney disease (DKD) is a major complication of type 1 diabetes (T1D). To better understand the development of DKD in modern clinical practice, we evaluated risk factors in participants from the T1D Exchange Registry who completed 5-years of longitudinal follow-up. METHODS: Participants had T1D duration ≥ 1 year, age ≥ 10 years, eGFR ≥ 60 ml/min and no albuminuria at enrollment, and at least two serum creatinine and urine albumin measurements recorded during follow-up. Adverse kidney outcomes were defined as eGFR ≪ 60 ml/min and/or albuminuria (ALB) defined by as two consecutive albumin/creatinine ratios or two out of the past three measurements ≫ 30 μg/mg at any follow-up data collection. Associations of baseline characteristics with adverse kidney outcomes were assessed. RESULTS: Among 3940 participants (mean age 41 ± 15 yrs, T1D duration 21 ± 13 yrs), 653 (16.6%) experienced an adverse kidney outcome: 268 (6.8%) experienced incident ALB only, 322 (8.2%) had eGFR decline to ≪60 ml/min without ALB, and 63 (1.6%) experienced eGFR ≪ 60 ml/min with ALB. In a multivariable analysis, higher HbA1c, higher SBP, lower DBP, older age and lower education level were associated with the development of adverse kidney outcomes (all p values ≤ 0.03). CONCLUSIONS: Improving modifiable risk factors, including glucose and blood pressure control, remain important to reduce the risk of DKD in T1D.
AIMS: Diabetic kidney disease (DKD) is a major complication of type 1 diabetes (T1D). To better understand the development of DKD in modern clinical practice, we evaluated risk factors in participants from the T1D Exchange Registry who completed 5-years of longitudinal follow-up. METHODS:Participants had T1D duration ≥ 1 year, age ≥ 10 years, eGFR ≥ 60 ml/min and no albuminuria at enrollment, and at least two serum creatinine and urine albumin measurements recorded during follow-up. Adverse kidney outcomes were defined as eGFR ≪ 60 ml/min and/or albuminuria (ALB) defined by as two consecutive albumin/creatinine ratios or two out of the past three measurements ≫ 30 μg/mg at any follow-up data collection. Associations of baseline characteristics with adverse kidney outcomes were assessed. RESULTS: Among 3940 participants (mean age 41 ± 15 yrs, T1D duration 21 ± 13 yrs), 653 (16.6%) experienced an adverse kidney outcome: 268 (6.8%) experienced incident ALB only, 322 (8.2%) had eGFR decline to ≪60 ml/min without ALB, and 63 (1.6%) experienced eGFR ≪ 60 ml/min with ALB. In a multivariable analysis, higher HbA1c, higher SBP, lower DBP, older age and lower education level were associated with the development of adverse kidney outcomes (all p values ≤ 0.03). CONCLUSIONS: Improving modifiable risk factors, including glucose and blood pressure control, remain important to reduce the risk of DKD in T1D.
Authors: Rodolfo J Galindo; Christopher G Parkin; Grazia Aleppo; Anders L Carlson; Davida F Kruger; Carol J Levy; Guillermo E Umpierrez; Janet B McGill Journal: Diabetes Technol Ther Date: 2021-04-27 Impact factor: 6.118