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Ren Fail. 2019 Nov;41(1):427-433. doi: 10.1080/0886022X.2019.1614057.

Risk factors for diabetic kidney disease in adults with longstanding type 1 diabetes: results from the Canadian Study of Longevity in Diabetes.

Author information

1
a Department of Medicine, Division of Nephrology , University of Toronto , Toronto , Canada.
2
b Department of Health Research Methods, Evidence, and Impact , McMaster University , Hamilton , Canada.
3
c Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto , Canada.
4
d Department of Pediatrics, Division of Endocrinology and Department of Medicine, Division of Nephrology , University of Colorado School of Medicine , Aurora , CO , USA.
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e Department of Medicine, Division of Endocrinology and Metabolism , Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada.
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f Research Division , Joslin Diabetes Center , Boston , MA , USA.
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g Department of Ophthalmology and Vision Sciences Faculty of Medicine , University of Toronto , Toronto , Canada.
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h Joint Department of Medical Imaging, University of Toronto, Toronto, Canada and Department of Medical Imaging , Western University , London , Canada.
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i Department of Medicine, Division of Neurology , University Health Network, University of Toronto , Toronto , Canada.
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j Department of Medicine, Division of Endocrinology and Metabolism , Mount Sinai Hospital, University of Toronto , Toronto , Canada.
11
k Department of Physiology , University of Toronto , Toronto , Canada.
12
l Department of Physiology and Banting and Best Diabetes Centre , University of Toronto , Toronto , Canada.

Abstract

Objectives: Diabetic kidney disease (DKD) is an independent predictor of cardiovascular morbidity and mortality in type 1 diabetes (T1D). We aimed to explore clinical and biochemical factors, including the achievement of American Diabetes Association (ADA) recommended targets associated with DKD in people living with T1D for ≥50 years. Methods: This was a post hoc analysis of a cross-sectional study of 75 participants enrolled in the Canadian Study of Longevity in T1D. We explored diabetes-related complications, including neuropathy, retinopathy, cardiovascular disease, and DKD. Study participants were dichotomized based on the achievement of ADA recommended targets as the low-target group (achieving ≤4 targets, n = 31) and high-target group (achieving >4 targets, n = 44). The outcome of interest was DKD defined by estimated glomerular filtration rate (eGFR) values <60/mL/min/1.73 m2 and/or 24-h albumin excretion >30 mg. Multivariable logistic regression models were employed to estimate odds ratios (ORs) for DKD with 95% confidence intervals (CIs). Results: Of the 75 participants with prolonged T1D duration (45% male, mean age 66 years), 25 participants had DKD and 50 did not. There was no statistical difference between the high- and low-target groups in terms of age and body mass index. eGFR was significantly higher and the prevalence of diabetic retinopathy was significantly lower in the high-target group. Older age at diagnosis of T1D and lower frequency component to high-frequency component ratio increased the odds of having DKD. Conclusions: In adults with prolonged T1D duration, older age at diagnosis and lower heart rate variability may be associated with DKD.

KEYWORDS:

Type 1 diabetes; diabetic kidney disease; diabetic neuropathy; diabetic retinopathy

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