Background: While children with type 1 diabetes (T1D) may be at risk for chronic kidney disease (CKD) , data describing changes in kidney function from diagnosis is lacking. Currently, Canadian guidelines do not recommend routine monitoring of serum creatinine in these children. As part of a quality improvement initiative, we implemented routine serum creatinine monitoring. In this study, we describe estimated glomerular filtration rate (eGFR) trajectories in children with T1D.
Methods: This longitudinal cohort study involved children with T1D followed in the Diabetes Clinic, who had ≥2 eGFR measurements. Data was collected from health records from 2016 to 2021. Annualized change in eGFR was calculated using the Bedside Schwartz equation, and a declining trajectory was defined a priori as <-3 ml/min/1.73m2 per year. Latent class mixed models were used to categorize eGFR trajectories, and patient characteristics were compared between trajectories.
Results: Of the 307 participants, 46% were male; the median age at diagnosis and duration of T1D was 6.2 years and 6.9 years, respectively. Three eGFR trajectories were identified: stable-declining from normal baseline (93.8%) , rapidly declining from high baseline (4.5%) , and rapidly inclining from normal baseline (1.6%) . During their follow-up, 68 (22%) patients had an eGFR <90 ml/min/1.73 m2. Increasing BMI and blood pressure were observed in patients with a declining trajectory (46.9% of all patients) .
Conclusion: Nearly half of children with T1D in this cohort had a declining eGFR trajectory. Notably, 22% of these children are at risk for CKD (eGFR <90 ml/min/1.73 m2) early in their T1D course. These findings, along with the steady rise in blood pressure, are concerning given the increased risk of CKD and end-stage renal disease in adults with T1D. These data suggest that careful monitoring of serum creatinine and blood pressure at baseline and regular intervals is warranted in children with T1D.
K. Favel: None. C. Mammen: None. C. Panagiotopoulos: Speaker's Bureau; Eli Lilly and Company.
BC Children's Hospital Research Institute, Canucks for Kids Fund Diabetes Legacy Grant (FAS #: F21-02506)