Diabetic Kidney Disease: A Determinant of Cardiovascular Risk in Type 1 Diabetes.

Abstract

Diabetes, regardless of type, has well-accepted vascular consequences. In fact, atherosclerotic cardiovascular disease (CVD) is the most important cause of death attributable to diabetes (1). Acute complications of diabetes such as hypoglycemia, hyperglycemia, and diabetic ketoacidosis are important causes of morbidity and mortality beginning early in its course. However, microvascular and macrovascular complications drive excess mortality over the long term (2–4). Diabetic kidney disease (DKD) is strongly associated with CVD (5). DKD may be a marker of cumulative vascular damage due to diabetes or may causally promote CVD through several mechanisms, such as blood pressure dysregulation, retention of uremic toxins, anemia, and altered mineral metabolism. Provocative studies suggest that the preponderance of excess CVD risk in both types 1 and 2 diabetes is restricted to people with DKD (6–8). The question posed by Groop et al. (9) in this issue of Diabetes Care was whether patients with type 1 diabetes have heightened CVD mortality risk in the absence of DKD compared with people without diabetes. To examine this question, they looked at two different databases. The first was a registry of 10,737 Finnish children followed for 10 years after the initial diagnosis of type 1 diabetes, a period considered generally too early for DKD development. The mortality rate of children in the Finnish registry was compared with that of the general population as a standardized mortality ratio (SMR) that adjusts for demographic characteristics. Children with diabetes had a mortality rate of 8 per 10,000 person-years, yielding an SMR of 2.6. (An SMR …