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Diabetic nephropathy in 27,805 children, adolescents and adults with type 1 diabetes: effect of diabetes duration, HbA1c, hypertension, dyslipidemia, diabetes onset and gender

¹ Pediatric Endocrinology and Diabetes, Charité Children's Hospital, Berlin, Germany
² Pediatric Endocrinology and Diabetes, University Hospital for Children and Adolescents, Leipzig, Germany
³Pediatrics, Medical University of Innsbruck, Austria
⁴ Pediatric Diabetology, Children's Hospital, Leverkusen, Germany
⁵ Children's Hospital, Klinikum Augsburg, Germany
⁶ Internal Medicine II, SLK-Kliniken Heilbronn, Germany
⁷ Epidemiology, University of Ulm, Germany

klemens.raile{at}charite.de

ABSTRACT

OBJECTIVE:To give an up to date profile of nephropathy and involvement of risk factors in a large, prospective cohort of patients with type 1 diabetes and largely pediatric and adolescent onset of disease.

RESEARCH DESIGN AND METHODS:27,805 patients from the nationwide, prospective DPV-survey were included in the present analysis. Inclusion criteria were at least two documented urine analysis with identical classification. Urine analysis, treatment regimens, diabetes complications and risk factors were recorded prospectively. Baseline characteristics were: age at diagnosis 9.94 yrs (median; interquartile range 5.8-14.3), age at last visit 16.34 yrs (12.5-22.2) and follow up time 2.5 yrs (0.43-5.3). Cumulative incidence of nephropathy was tested by Kaplan-Meier analysis, association with risk factors by logistic regression.

RESULTS:Nephropathy was classified as normal in 26,605, microalbuminuric in 919, macroalbuminuric in 78 and end stage renal disease (ESRD) in 203 patients. After calculated diabetes duration of 40 years, 25.4 % (95% confidence interval 22.3-28.3) had microalbuminuria and 9.4 % (8.3-11.4) macroalbuminuria or ESRD. Risk factors for microalbuminuria were diabetes duration (odds ratio 1.033, p< 0.0001), HbA1c (1.13, p< 0.0001), LDL-cholesterol (1.003, p< 0.0074) and blood pressure (1.008, p< 0.0074), while childhood diabetes onset (1.011, p< 0.0001) was protective. Male gender was associated with development of macroalbuminuria.

CONCLUSION:Diabetes duration, HbA1c, dyslipidemia, blood pressure and male gender were identified as risk factors for nephropathy. Therefore, beside best possible metabolic control, early diagnosis and prompt treatment of dyslipidemia and hypertension is mandatory in patients with type 1 diabetes.

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