Abstract
We evaluated 2,656 patients with type 1 diabetes mellitus and preserved renal function from the database of the Italian Association of Clinical Diabetologists network to identify clinical predictors for the development of chronic kidney disease. We measured estimated glomerular filtration rate (eGFR), urinary albumin excretion, HbA1c, lipids, blood pressure. Over a 5-year period 4.3% (n = 115) developed reduced eGFR (<60 ml/min/1.73 m2), 18.0% (n = 477) albuminuria, and 21.0% (n = 559) either one of the renal endpoints (CKD). Odds ratios for eGFR below 90 mL/min/1.73 m2 (1.48, P < 0.001), HbA1c (1.13, P = 0.002), triglycerides (1.04, P = 0.021 by 20 mg/dL), low density lipoprotein cholesterol (LDL-c) (0.95, P = 0.002 by 10 mg/dL) were independently related to the onset of CKD. Known duration of diabetes (1.15, P = 0.014 by 10 years), HbA1c (1.16, P = 0.001), triglycerides (1.05, P = 0.005 by 20 mg/dL), LDL-c (0.95, P = 0.003 by 10 mg/dL), antihypertensive treatment (2.28, P = 0.018) were related to the onset of albuminuria while age and presence of baseline eGFR values between 90 and 60 mL/min/1.73 m2, independently affected the developing of reduced eGFR (OR 1.95, P < 0.001 by 10 years and 2.92, P < 0.001). Patients with type 1 diabetes mellitus and unfavorable CV risk profile are at high risk of developing CKD. The two main traits of CKD share several determinants, although with some specificities.
Highlights
Diabetes is one of the largest health emergencies of the 21st century
The natural history of diabetic nephropathy in patients with type 1 diabetes mellitus has traditionally been associated with an increase in urinary albumin excretion rate (AER), which is the first sign of renal damage and may foster progression to macroalbuminuria and later on decrease in GFR12
The bold value refers to statistical significance (p < 0.05). This is the first survey from Italy investigating the natural history of kidney dysfunction in a large sample of adult patients with type 1 diabetes mellitus, providing important hints regarding clinical risk factors which predict Chronic kidney disease (CKD) and its traits, in a real life setting
Summary
Diabetes is one of the largest health emergencies of the 21st century. The International Diabetes Federation Diabetes Atlas estimated that in 2015, there were 415 million patients with diabetes worldwide and by 2040 this figure will rise to 642 million people. 5.0 million people aged between 20 and 79 years died from diabetes in 2015, which accounts for 14.5% of global all-cause mortality among people in this age group[1]. This risk excess seems to be essentially driven by kidney disease[3]. The natural history of diabetic nephropathy in patients with type 1 diabetes mellitus has traditionally been associated with an increase in urinary albumin excretion rate (AER), which is the first sign of renal damage and may foster progression to macroalbuminuria and later on decrease in GFR12. Whether renal lesions found in non albuminuric CKD are due to diabetes or may in part recognize different pathogenetic mechanisms is sometimes difficult to ascertain in clinical practice as renal biopsies are not routinely performed in most of these patients
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