Biologic and social factors predict incident kidney disease in type 1 diabetes: Results from the T1D exchange clinic network

Janet B. McGill, Mengdi Wu, Rodica Pop-Busui, Kara Mizokami-Stout, William V. Tamborlane, Grazia Aleppo, Rose A. Gubitosi-Klug, Michael J. Haller, Steven M. Willi, Nicole C. Foster*, Chelsea Zimmerman, Ingrid Libman, Sarit Polsky, Michael R. Rickels

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Article number107400
JournalJournal of Diabetes and Its Complications
Volume33
Issue number10
DOIs
StatePublished - Oct 2019

Keywords

  • Diabetes management
  • Diabetic kidney disease
  • Glycemic management
  • T1D exchange
  • Type 1 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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