Predicting renal disease progression in a large contemporary cohort with type 1 diabetes mellitus

Abstract

Aims/hypothesis The aim of this study was to provide data from a contemporary population-representative cohort on rates and predictors of renal decline in type 1 diabetes. Methods We used data from a cohort of 5777 people with type 1 diabetes aged 16 and older, diagnosed before the age of 50, and representative of the adult population with type 1 diabetes in Scotland (Scottish Diabetes Research Network Type 1 Bioresource; SDRNT1BIO). We measured serum creatinine and urinary albumin/creatinine ratio (ACR) at recruitment and linked the data to the national electronic healthcare records. Results Median age was 44.1 years and diabetes duration 20.9 years. The prevalence of CKD stages G1, G2, G3 and G4 and endstage renal disease (ESRD) was 64.0%, 29.3%, 5.4%, 0.6%, 0.7%, respectively. Micro/macroalbuminuria prevalence was 8.6% and 3.0%, respectively. The incidence rate of ESRD was 2.5 (95% CI 1.9, 3.2) per 1000 person-years. The majority (59%) of those with chronic kidney disease stages G3-G5 did not have albuminuria on the day of recruitment or previously. Over 11.6 years of observation, the median annual decline in eGFR was modest at −1.3 ml min −1 [1.73 m] −2 year −1 (interquartile range [IQR]: −2.2, −0.4). However, 14% experienced a more significant loss of at least 3 ml min −1 [1.73 m] −2. These decliners had more cardiovascular disease (OR 1.9, p = 5 × 10 −5) and retinopathy (OR 1.3 p = 0.02). Adding HbA 1c , prior cardiovascular disease, recent mean eGFR and prior trajectory of eGFR to a model with age, sex, diabetes duration, current eGFR and ACR maximised the prediction of final eGFR (r 2 increment from 0.698 to 0.745, p < 10 −16). Attempting to model nonlinearity in eGFR decline or to detect latent classes of decliners did not improve prediction. Conclusions These data show much lower levels of kidney disease than historical estimates. However, early identification of those destined to experience significant decline in eGFR remains challenging.

Urinary Kringle Domain-Containing Protein HGFL: A Validated Biomarker of Early Sickle Cell Anemia-Associated Kidney Disease

“…Cohorts from the large interventional studies were used previously for the identification of urinary biomarkers to improve prediction of renal disease progression [9]. However, this approach is not feasible for rare diseases.…”

First, Do No Harm: Critical Appraisal of Protein Restriction for Diabetic Kidney Disease

“…In these studies, patients with type 1 diabetes received interventions consisting of low-protein diets with a protein intake of 0.6 g/kg, and rapid progression was observed in the control group with a decrease in the eGFR at an annual rate of 12.7-25 mL/min/1.73 m 2 . However, the annual rates of eGFR decrease are 2.7 mL/min/1.73 m 2 in patients with CKD stage G3 (30 mL/min/1.73 m 2 < eGFR < 60 mL/min/1.73 m 2 ) type 1 diabetes and 3.7 mL/min/ 1.73 m 2 in those with CKD stage G4 (15 mL/min/1.73 m 2 < eGFR < 30 mL/min/1.73 m 2 ) type 1 diabetes [48]. Studies that discuss extreme conditions in which the eGFR decreases at an annual rate of 12.7-25 mL/min/1.73 m 2 cannot be used as references for everyday practice.…”

Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options?

“…Due to its complex pathogenesis, DKD presents a wide clinical variability. The incidence rate of KF in type 2 DM (T2DM) is 0.29% at 10 years and 0.74% at 20 years from the diagnosis of diabetes [10], while for type 1 diabetes mellitus (T1DM) it is 2.5 per 1000 person-years [11]. However, 40%-53% of diabetics have mild renal disease [12,13].…”