Risk Factors for Adverse Kidney Disease Outcomes in Type 1 Diabetes (T1D)
Authors: MCGILL JANET B. , WU MENGDI , POP-BUSUI RODICA , MIZOKAMI-STOUT KARA R. , TAMBORLANE WILLIAM V. , ALEPPO GRAZIA , GUBITOSI-KLUG ROSE , HALLER MICHAEL J. , WILLI STEVEN M. , FOSTER NICOLE C. , ZIMMERMAN CHELSEA , LIBMAN INGRID , POLSKY SARIT , RICKELS MICHAEL R. 
Published: June 2018

Diabetic kidney disease (DKD) is a major complication of T1D. To better understand the risks of developing DKD, we evaluated risk factors in participants from the T1D Exchange registry who completed 5-year follow-up. Participants had at least two eGFR and albuminuria measurements recorded during the 5 year period; also T1D duration ≥1 year, age ≥10 years, eGFR ≥60 ml/minute and no documented albuminuria at enrollment. Adverse kidney outcomes were defined as eGFR &lt;60 ml/minute and/or micro/macroalbuminuria (micro/macroALB) at any follow-up visit. Univariate chi-square tests, Wilcoxon tests and multivariate logistic regression were used to determine associations between adverse kidney outcomes and risk factors. Among 3,296 participants (mean age 41 ± 15 years, T1D duration 21± 13 years, mean HbA1c 7.6 ± 1.2%, 91% white non-Hispanic,56% female at enrollment) with valid data, 547 (16.6%) experienced an adverse kidney outcome during 5-year follow-up: 224 (6.8%) experienced micro/macroALB while eGFR remained ≥60 ml/minute, 274 (8.3%) had a decline in eGFR to &lt;60 ml/minute without micro/macroALB, and 49 (1.5%) experienced eGFR &lt;60 ml/minute with micro/macroALB. Higher HbA1c, higher SBP, lower DBP as well as older age and lower education level were the significant risk factors for the development of an adverse kidney outcome over 5 years (Table). Control of risk factors and better glycemic control may minimize future DKD.

Disclosure
J.B. McGill: Research Support; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Aegerion Pharmaceuticals. Consultant; Self; Bayer AG, Dexcom, Inc., Intarcia Therapeutics, Inc.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., MannKind Corporation. Research Support; Self; Novartis Pharmaceuticals Corporation. Consultant; Self; Novo Nordisk A/S. M. Wu: None. R. Pop-Busui: Research Support; Self; AstraZeneca. K.R. Mizokami-Stout: None. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Medtronic MiniMed, Inc., Novo Nordisk Inc., Sanofi, Takeda Pharmaceuticals U.S.A., Inc. G. Aleppo: Research Support; Self; AstraZeneca, Novo Nordisk Inc.. Consultant; Self; Dexcom, Inc.. Advisory Panel; Self; Novo Nordisk Inc.. R. Gubitosi-Klug: None. M.J. Haller: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim GmbH. Other Relationship; Self; Caladrius Biosciences, Inc.. Consultant; Self; GlaxoSmithKline plc., JAEB Center For Health Research. N.C. Foster: None. C. Zimmerman: None. I. Libman: Consultant; Self; Novo Nordisk A/S. S. Polsky: Research Support; Self; Dexcom, Inc.. Other Relationship; Self; T1D Exchange. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. M.R. Rickels: Consultant; Self; Hua Medicine, Xeris Pharmaceuticals, Inc..