Are All Patients With Type 1 Diabetes Destined for Dialysis if They Live Long Enough? Probably Not.

Abstract

Over the past three decades there have been numerous innovations, supported by large outcome trials that have resulted in improved blood glucose and blood pressure control, ultimately reducing cardiovascular (CV) risk and progression to nephropathy in type 1 diabetes (T1D) (1,2). The epidemiological data also support the concept that 25–30% of people with T1D will progress to end-stage renal disease (ESRD). Thus, not everyone develops progressive nephropathy that ultimately requires dialysis or transplantation. This is a result of numerous factors, including the competing CV risk of death as well as blood glucose and pressure control. Good glycemic and blood pressure control have been documented in long-term trials to markedly slow nephropathy progression, with effects of blood pressure control seen as early as 2.5 years and of glucose control at 5–7 years (3,4). It is well documented that the presence of diabetic kidney disease increases the risk of CV events and death in persons with diabetes (5,6). Moreover, this is independent of hypertension. Data from two recent studies reported in this issue of Diabetes Care examine the long-term incidence of chronic kidney disease (CKD) in T1D. Costacou and Orchard (7) examined a cohort of 932 people evaluated for 50-year cumulative kidney complication risk in the Pittsburgh Epidemiology of Diabetes Complications study. They used both albuminuria levels and ESRD/transplant data for assessment. By 30 years’ duration of diabetes, ESRD affected 14.5% and by 40 years it affected 26.5% of the group with onset of T1D between 1965 and 1980. For those who developed diabetes between 1950 and 1964, the proportions developing ESRD were …