Type 1 Diabetes Onset in Childhood Raises Risk for Kidney Disease Later in Life

A type 1 diabetes duration of 50 years is associated with a higher cumulative risk of kidney complications such as end-stage renal disease (ESRD), microalbuminuria, and macroalbuminuria, according to a recent study. However, the incidence of ESRD declines significantly after a diabetes duration of 40 years.

It is commonly believed that only a few patients with type 1 diabetes develop advanced kidney disease and that the incidence of advanced kidney disease is higher among men and lower among individuals who had received a diabetes diagnosis at a younger age. However, since few patients with type 1 diabetes have survived to older ages until recently, little is currently known about the long-term risks of kidney complications in these patients.
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For their study, the researchers assessed the 50-year cumulative risk of kidney complications among 932 patients who were diagnosed with type 1 diabetes as a child from 1950 to 1980.

Mean patient age at baseline was 29 years, and all patients had type 1 diabetes for a mean duration of 19 years at baseline. A total of 130 patients were assessed over the course of 25 years via periodic surveys, and 658 were assessed via biennial surveys and a maximum of 9 examinations throughout the study period.

Microalbuminuria was defined as an albumin excretion rate of 20 to 199 μg/min, macroalbuminuria was defined as an albumin excretion rate of 200 μg/min or more, and ESRD was defined as having received dialysis or kidney transplantation.

Results showed that 60% of patients had developed ESRD, 72% had developed macroalbuminuria, and 88% had developed microalbuminuria by 50 years of diabetes duration. However, study data from recent cohorts had demonstrated a 45% decline in the cumulative incidence of ESRD at 40 years of diabetes duration, a 3% increase in microalbuminuria, and no change in macroalbuminuria.

Onset of type 1 diabetes before age 6 years was associated with the lowest 50-year risk of cumulative kidney complications, the researchers noted. Additionally, the incidence of complications was generally similar between sexes.

“Some degree of kidney disease in [type 1 diabetes] is virtually universal at long durations and not declining, which has major implications for health care and research strategies,” the researchers concluded. “ESRD has declined, but continues to affect [25% or more] of the population by 40 years duration.”

—Christina Vogt

Reference:

Costacou T, Orchard TJ. Cumulative kidney complication risk by 50 years of type 1 diabetes: the effects of sex, age, and calendar year at onset. Diabetes Care. 2017;40(9). https://doi.org/10.2337/dc17-1118.