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. 2019 Jan;42(1):93-101.
doi: 10.2337/dc18-1369. Epub 2018 Nov 19.

Variations in Risk of End-Stage Renal Disease and Risk of Mortality in an International Study of Patients With Type 1 Diabetes and Advanced Nephropathy

Jan Skupien  1   2 , Adam M Smiles  2 , Erkka Valo  3 , Tarunveer S Ahluwalia  4 , Beata Gyorgy  5 , Niina Sandholm  3 , Stephanie Croall  2 , Maria Lajer  4 , Kevin McDonnell  2 , Carol Forsblom  3 , Valma Harjutsalo  3   6 , Michel Marre  7 , Andrzej T Galecki  8   9 , David-Alexandre Tregouet  5 , Chun Yi Wu  8 , Josyf C Mychaleckyj  10 , Helen Nickerson  11 , Marlon Pragnell  11 , Stephen S Rich  10 , Marcus G Pezzolesi  12 , Samy Hadjadj  13   14 , Peter Rossing  4   15 , Per-Henrik Groop  3   16 , Andrzej S Krolewski  17   18
Affiliations

Variations in Risk of End-Stage Renal Disease and Risk of Mortality in an International Study of Patients With Type 1 Diabetes and Advanced Nephropathy

Jan Skupien et al. Diabetes Care. 2019 Jan.

Abstract

Objective: Patients with type 1 diabetes and diabetic nephropathy are targets for intervention to reduce high risk of end-stage renal disease (ESRD) and deaths. This study compares risks of these outcomes in four international cohorts.

Research design and methods: In the 1990s and early 2000s, Caucasian patients with type 1 diabetes with persistent macroalbuminuria in chronic kidney disease stages 1-3 were identified in the Joslin Clinic (U.S., 432), Finnish Diabetic Nephropathy Study (FinnDiane) (Finland, 486), Steno Diabetes Center Copenhagen (Denmark, 368), and INSERM (France, 232) and were followed for 3-18 years with annual creatinine measurements to ascertain ESRD and deaths unrelated to ESRD.

Results: During 15,685 patient-years, 505 ESRD cases (rate 32/1,000 patient-years) and 228 deaths unrelated to ESRD (rate 14/1,000 patient-years) occurred. Risk of ESRD was associated with male sex; younger age; lower estimated glomerular filtration rate (eGFR); higher albumin/creatinine ratio, HbA1c, and systolic blood pressure; and smoking. Risk of death unrelated to ESRD was associated with older age, smoking, and higher baseline eGFR. In adjusted analysis, ESRD risk was highest in Joslin versus reference FinnDiane (hazard ratio [HR] 1.44, P = 0.003) and lowest in Steno (HR 0.54, P < 0.001). Differences in eGFR slopes paralleled risk of ESRD. Mortality unrelated to ESRD was lowest in Joslin (HR 0.68, P = 0.003 vs. the other cohorts). Competing risk did not explain international differences in the outcomes.

Conclusions: Despite almost universal renoprotective treatment, progression to ESRD and mortality in patients with type 1 diabetes with advanced nephropathy are still very high and differ among countries. Finding causes of these differences may help reduce risk of these outcomes.

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Figures

Figure 1
Figure 1
Comparison of cumulative risk of ESRD and mortality unrelated to ESRD after 10 years of follow-up among the four study cohorts ordered by decreasing risk of ESRD.
See this image and copyright information in PMC

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