medwireNews: US researchers warn that some degree of kidney disease is “virtually universal” among patients who have been diagnosed with type 1 diabetes for a long time.
There were encouraging signs that rates of end-stage renal disease had decreased markedly among those diagnosed with type 1 diabetes in more recent years compared with those diagnosed earlier on. However, the researchers say their results suggest this improvement “reflects better management of nephropathy rather than its prevention.”
Diabetes diagnosis before the age of 6 years was associated with the lowest kidney disease risk, “consistent with the hypothesis that pathogenesis may be different in this subgroup.”
The team studied the risk for kidney complications among 932 people who were diagnosed with type 1 diabetes in childhood, or seen within a year of diagnosis, at the Children’s Hospital of Pittsburgh, Pennsylvania, USA, between 1950 and 1980.
These included 144 patients who died before the study baseline in 1986 to 1988, and 130 who provided only survey information but had not attended clinical examinations during the 25-year follow-up. The mean age of the cohort was 27.4 years at the start of the study and the mean age at diabetes onset was 8.7 years.
Tina Costacou and Trevor Orchard from the University of Pittsburgh report that end-stage renal disease, defined as dialysis or kidney transplantation, affected 61.3% of patients who had type 1 diabetes for 50 years. Micro- and macroalbuminuria, defined as corresponding albumin excretion rates of 20 to 199 μg/min and 200 μg/min or more, occurred in 88.0% and 71.8%, respectively.
Rates of end-stage renal disease among patients with a type 1 diabetes duration of 40 years dramatically declined, by 45%, between a cohort diagnosed between 1950 and 1964 and a later one diagnosed between 1965 and 1980.
However, the researchers note that 26.5% of the more recent group still had a diagnosis of end-stage renal disease (versus 48.5% of the older cohort), and 39.1% had either end-stage renal disease or had died. Furthermore, the cumulative incidence of micro- and macroalbuminuria remained “essentially identical” between the older and more recent diagnosis cohorts.
Reporting in Diabetes Care, they call their observations “alarming” and predict that the number of patients with type 1 diabetes with advanced kidney disease will rise with their life expectancy, “with dire implications for the patient as well as for the health care system.”
By Anita Chakraverty
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