Risk Factors for Adverse Kidney Disease Outcomes in Type 1 Diabetes (T1D)

Diabetic kidney disease (DKD) is a major complication of T1D. To better understand the risks of developing DKD, we evaluated risk factors in participants from the T1D Exchange registry who completed 5-year follow-up. Participants had at least two eGFR and albuminuria measurements recorded during the 5 year period; also T1D duration ≥1 year, age ≥10 years, eGFR ≥60 ml/minute and no documented albuminuria at enrollment. Adverse kidney outcomes were defined as eGFR <60 ml/minute and/or micro/macroalbuminuria (micro/macroALB) at any follow-up visit. Univariate chi-square tests, Wilcoxon tests and multivariate logistic regression were used to determine associations between adverse kidney outcomes and risk factors. Among 3,296 participants (mean age 41 ± 15 years, T1D duration 21± 13 years, mean HbA1c 7.6 ± 1.2%, 91% white non-Hispanic,56% female at enrollment) with valid data, 547 (16.6%) experienced an adverse kidney outcome during 5-year follow-up: 224 (6.8%) experienced micro/macroALB while eGFR remained ≥60 ml/minute, 274 (8.3%) had a decline in eGFR to <60 ml/minute without micro/macroALB, and 49 (1.5%) experienced eGFR <60 ml/minute with micro/macroALB. Higher HbA1c, higher SBP, lower DBP as well as older age and lower education level were the significant risk factors for the development of an adverse kidney outcome over 5 years (Table). Control of risk factors and better glycemic control may minimize future DKD.