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J Diabetes Complications. 2018 Oct;32(10):940-946. doi: 10.1016/j.jdiacomp.2018.07.007. Epub 2018 Jul 19.

Risk factors for decline in renal function among young adults with type 1 diabetes.

Author information

1
Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, 89081 Ulm, Germany; German Centre for Diabetes Research (DZD), 85764 Munich, Neuherberg, Germany. Electronic address: anke.schwandt@uni-ulm.de.
2
Department of Internal Medicine I, Division of Endocrinology, University Hospital, 60590 Frankfurt am Main, Germany.
3
Geriatric Centre Ulm/Alb-Donau, Geriatric Medicine at Ulm University, Agaplesion Bethesda Hospital Ulm, 89081 Ulm, Germany.
4
Clinic for Gastroenterology and Gastrointestinal Oncology, Endocrine Unit, University Medical Centre Göttingen,37075 Göttingen, Germany.
5
Hospital zum Heiligen Geist Kempen, Akademisches Lehrkrankenhaus, Heinrich Heine University Düsseldorf, 47906 Kempen, Germany.
6
Department of Internal Medicine, Hospital Melk, 3390 Melk, Austria.
7
Department of General Internal Medicine, Endocrinology and Diabetology, Helios Kliniken Schwerin, 19049 Schwerin, Germany.
8
Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, 89081 Ulm, Germany; German Centre for Diabetes Research (DZD), 85764 Munich, Neuherberg, Germany.

Abstract

AIMS:

To investigate risk factors for declining renal function among subjects with type-1-diabetes.

METHODS:

Observational study based on data from the diabetes registry DPV. 4424 type-1-diabetes subjects aged ≥18 years, age at onset <18 years were identified. Modification of Diet in Renal Disease (MDRD) equation was used to estimate glomerular filtration rate (eGFR). Annual rate of renal decline was estimated for each patient using hierarchic linear regression models. Additional regression models were fitted to adjust for covariates.

RESULTS:

Median age was 26 [Q1; Q3: 21; 39] years. Annual decline of renal function was -1.22 (95% CI: -1.50; -0.94) ml/min/1.73 m2. At baseline, higher eGFR was related to more rapid decline compared to impaired or reduced eGFR (GFR ≥ 90: -2.06 (-2.35; -1.76), 60 ≤ GFR < 90: 0.45 (0.08; 0.81), GFR < 60: 0.52 (-0.24; 1.29) ml/min/1.73 m2, p < 0.01). During follow-up, the highest decline was associated with reduced renal function, whereas the lowest decline was related to normal kidney function (p < 0.01). Poor metabolic control (p = 0.04), hypertension (p < 0.01) and albuminuria (p = 0.03) were associated with more rapid loss of kidney function. No difference was observed among insulin regimen.

CONCLUSION:

Among this large type-1-diabetes cohort, more rapid loss of kidney function was related to higher baseline eGFR, log-term worse metabolic control and diabetic comorbidities.

KEYWORDS:

Diabetic comorbidities; Kidney function; Renal decline; Risk factors for renal decline; Type-1-diabetes

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