Diabetic Nephropathy in 27,805 Children, Adolescents, and Adults With Type 1 Diabetes
Effect of diabetes duration, A1C, hypertension, dyslipidemia, diabetes onset, and sex
- Klemens Raile, MD1,
- Angela Galler, MD2,
- Sabine Hofer, MD3,
- Antje Herbst, MD4,
- Desiree Dunstheimer, MD5,
- Petra Busch, MD6 and
- Reinhard W. Holl, MD7
- 1Department of Pediatric Endocrinology and Diabetes, Charité Children's Hospital, Berlin, Germany
- 2Department of Pediatric Endocrinology and Diabetes, University Hospital for Children and Adolescents, Leipzig, Germany
- 3Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
- 4Department of Pediatric Diabetology, Children's Hospital, Leverkusen, Germany
- 5Children's Hospital, Klinikum Augsburg, Ausburg, Germany
- 6Department of Internal Medicine II, SLK-Kliniken Heilbronn, Heilbronn, Germany
- 7Department of Epidemiology, University of Ulm, Ulm, Germany
- Address correspondence and reprint requests to Klemens Raile, MD, Department of Pediatric Endocrinology and Diabetes, Charité Children's Hospital, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail: klemens.raile{at}charite.de
Abstract
OBJECTIVE—To give an up-to-date profile of nephropathy and the 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—A total of 27,805 patients from the nationwide, prospective German Diabetes Documentation System survey were included in the present analysis. Inclusion criteria were at least two documented urine analyses with identical classification. Urine analyses, treatment regimens, diabetes complications, and risk factors were recorded prospectively. Baseline characteristics were age at diagnosis 9.94 years (median [interquartile range 5.8–14.3]), age at last visit 16.34 years (12.5–22.2), and follow-up time 2.5 years (0.43–5.3). Cumulative incidence of nephropathy was tested by Kaplan-Meier analysis and 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% CI 22.3–28.3) had microalbuminuria and 9.4% (8.3–11.4) had macroalbuminuria or ESRD. Risk factors for microalbuminuria were diabetes duration (odds ratio 1.033, P < 0.0001), A1C (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 sex was associated with the development of macroalbuminuria.
CONCLUSIONS—Diabetes duration, A1C, dyslipidemia, blood pressure, and male sex were identified as risk factors for nephropathy. Therefore, besides the best possible metabolic control, early diagnosis and prompt treatment of dyslipidemia and hypertension is mandatory in patients with type 1 diabetes.
- AER, albumin excretion rate
- DCCT, Diabetes Control and Complications Trial
- DPV, German Diabetes Documentation System
- ESRD, end-stage renal disease
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 13 July 2007. DOI: 10.2337/dc07-0282.
Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/dc07-0282.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted July 9, 2007.
- Received February 11, 2007.
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