550-P: Age at Diabetes Onset and Risk for Diabetic Kidney Disease

Diabetic kidney disease drives premature mortality among patients with type 1 diabetes. The role of age at diabetes onset is controversial. We analyzed risk for diabetic kidney disease according to age at onset of type 1 diabetes using follow-up of type 1 diabetic patients attending our tertiary referral center. 340 type 1 diabetic patients attending the Angers University Hospital in France between 1989 and 2000, were followed-up to 2018 or death. They were divided in tertiles of ages at type 1 diabetes onset: T1:1-13, T2:14-23, and T3: 24-40 years. The primary endpoint was first occurrence of macroalbuminuria (>300mg albumin/g creatinine), doubling of serum creatinine, estimated glomerular filtration rate (eGFR, CK-EPI formula) <60ml/min/1.73m², end stage renal disease (ESRD), or all-cause death. Multivariate analyses were done. Of 114 T1 participants, 11 (9.6%) developed macroalbuminuria, 5 (4.4%) doubling of serum creatinine, 14 (12.3%) eGFR<60ml/min/1.73m², 8 (7%) ESRD, and 14(12.3%) died. Of 119 T2 participants, 8 (.6.7%) developed macroalbuminuria, 1 (0.8%) doubling of serum creatinine, 7 (5.9%) eGFR<60ml/min/1.73m², 4(3.3%) ESRD, and 15(12.6%) died. Of 114 T3 participants, 3 (2.8%) developed macroalbuminuria, 1 (0.93%) doubling of serum creatinine, 4 (3.7%) eGFR<60ml/min/1.73m², none ESRD, and 31(29%) died. Using multivariate analysis, age<14years at type 1 diabetes onset increased risk for kidney disease: T1 vs. T2 HR=2.35(95% CI1.20-4.58), T1 vs. T3 HR=3.61(1.30-9.27), p<0.01.

Conclusions: Age <14 at type 1 diabetes onset was an independent risk factor for kidney disease in this >20-year monocentric follow-up study.