Abstract
AimsAlbuminuria is strongly associated with risk of renal dysfunction, cardiovascular disease and mortality. However, clinical guidelines diverge, and evidence is sparse on what risk factor levels regarding blood pressure, blood lipids and BMI are needed to prevent albuminuria in adolescents and young adults with type 1 diabetes.MethodsA total of 9347 children and adults with type 1 diabetes [mean age 15.3 years and mean diabetes duration 1.4 years at start of follow-up] from The Swedish National Diabetes Registry were followed from first registration until end of 2017. Levels for risk factors for a risk increase in nephropathy were evaluated, and the gradient of risk per 1 SD (standard deviation) was estimated to compare the impact of each risk factor.ResultsDuring the follow-up period, 8610 (92.1%) remained normoalbuminuric, 737 (7.9%) individuals developed micro- or macroalbuminuria at any time period of whom 132 (17.9% of 737) individuals developed macroalbuminuria. Blood pressure ≥ 140/80 mmHg was associated with increased risk of albuminuria (p ≤ 0.0001), as were triglycerides ≥ 1.0 mmol/L (p = 0.039), total cholesterol ≥ 5.0 mmol/L (p = 0.0003), HDL < 1.0 mmol/L (p = 0.013), LDL 3.5– < 4.0 mmol/L (p = 0.020), and BMI ≥ 30 kg/m2 (p = 0.033). HbA1c was the strongest risk factor for any albuminuria estimated by the measure gradient of risk per 1 SD, followed by diastolic blood pressure, triglycerides, systolic blood pressure, cholesterol and LDL. In patients with HbA1c > 65 mmol/mol (> 8.1%), blood pressure > 140/70 mmHg was associated with increased risk of albuminuria.ConclusionsPreventing renal complications in adolescents and young adults with type 1 diabetes need avoidance at relatively high levels of blood pressure, blood lipids and BMI, whereas very tight control is not associated with further risk reduction. For patients with long-term poor glycaemic control, stricter blood pressure control is advocated.
Highlights
Diabetic nephropathy (DN), known as diabetic kidney disease, occurs in 15–40% of all persons with type 1 diabetes
In this population-based cohort study using paediatric and adult registries in Sweden, we aimed to evaluate what levels of blood lipids, blood pressure and body mass index (BMI) in persons with type 1 diabetes are related to risk of nephropathy
Blood pressure and triglycerides had a significant impact, but not other studied variables. In this population-based cohort study, we used both pediatric and adult registries to evaluate the impact of various risk factors on the development of albuminuria in persons with type 1 diabetes
Summary
Diabetic nephropathy (DN), known as diabetic kidney disease, occurs in 15–40% of all persons with type 1 diabetes. This article belongs to the topical collection Diabetic Nephropathy, managed by Giuseppe Pugliese. Extended author information available on the last page of the article macroalbuminuria an essential risk factor for cardiovascular disease, including stroke, atrial fibrillation, heart failure and mortality [2,3,4]. Dyslipidaemia, diabetes duration and albumin excretion rate have been shown to be associated with progression of DN [7,8,9,10,11,12,13,14,15,16]. Recommendations regarding blood pressure diverge in guidelines from European Society of Cardiology (ESC), American College of Cardiology (ACC)/American Heart Association (AHA) and American Diabetes Association (ADA) [17,18,19].
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