Introduction & Objective: Chronic kidney disease (CKD) is a major issue in the management of people with type 1 diabetes (T1D). Intraindividual body weight variability (BWV) or cycling is associated with increased risk of cardiovascular events and all-cause death in T1D. We conducted a retrospective analysis of data from the DCCT/EDIC studies for the association between BWV and the risk of renal events.
Methods: Five BWV indices were calculated for 1,432 participants of the DCCT/EDIC studies taking into account body-weight measurements during the DCCT follow-up (average 6±2 years). Variability independent of the mean (VIM) was the main variable of interest. Six criteria of progression to CKD were studied during DCCT/EDIC follow-up (21 ± 4 years). Cox models were fitted to estimate associations of BWV indices with the outcomes. Hazard Ratios (HR) with 95% confidence interval (CI) were computed for 1 SD of the indices expressed as a Z-score.
Results: Progression to CKD stage 3 (eGFR<60ml/min/m2) during follow-up occurred in 128 participants (8.9%). A high VIM was significantly associated with occurrence of stage 3 CKD (adjusted HR 1.36 [95% CI, 1.12-1.63], p= 0.002), doubling of serum creatinine (1.36 [1.15-1.60], p=0.0005), decline in eGFR>3ml/min/m2 per year (1.47 [1.14-1.89], p=0.003), and “Certain drop in eGFR” KDIGO criterion (1.20 [1.02-1.41], p = 0.03), after adjustment for nephropathy risk factors at baseline and throughout follow-up, and use of nephroprotective drugs. VIM was also associated with the incidence of microalbuminuria (1.21 [1.08-1.36], p = 0.002) and macroalbuminuria (1.36 [1.14-1.61], p= 0.0009), adjusted for baseline covariates, but associations did not remain significant following adjustment for follow-up covariates. Similar results were observed for the other BWV indices.
Conclusion: BWV is significantly associated with an increased risk of renal events in people with T1D, regardless BMI and traditional risk factors.
M. Camoin: None. K. Mohammedi: None. P. Saulnier: Advisory Panel; Novo Nordisk. S. Hadjadj: Consultant; AstraZeneca. Research Support; Asten Santé, Air Liquide. Consultant; Bayer Inc., Boehringer-Ingelheim, Eli Lilly and Company. Research Support; LVL, Nestlé Health Science. Consultant; Novo Nordisk. Board Member; Valbiotis. Consultant; Sanofi. Research Support; Vitalaire. J. Gautier: Board Member; Sanofi. Other Relationship; Sanofi. Speaker's Bureau; AstraZeneca, Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Pfizer Inc. J. Riveline: Board Member; Abbott, Novo Nordisk A/S, Sanofi, Eli Lilly and Company, Medtronic, Dexcom, Inc., Insulet Corporation, Air Liquide, AstraZeneca. N. Venteclef: None. L. Potier: Research Support; Abbott. Consultant; AstraZeneca, Bayer Inc., Eli Lilly and Company, Novo Nordisk, Sanofi, Boehringer-Ingelheim. G. Velho: None.
