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05-06-2022 | Nephropathy | News

Renal prognosis improvements stalled in type 1 diabetes

Author: Eleanor McDermid


medwireNews: The risk for kidney disease has fallen for people diagnosed with type 1 diabetes in more recent decades, but is still substantial and has stopped decreasing, study results suggest.

Moreover, the likelihood of progressing from severe albuminuria to kidney failure remained the same for people diagnosed in the 1970s and 1990s, say Valma Harjutsalo (University of Helsinki, Finland) and co-researchers.

“Thus, despite advances in renoprotective treatment, a substantial risk of diabetic kidney disease remains,” they write in The Lancet Diabetes & Endocrinology.

The team looked at the renal outcomes of 1430 people with type 1 diabetes, randomly selected from all people diagnosed with the condition before the age of 15 years in Finland between 1970 and 1999.

During a median 25 years of follow-up, 19.1% of this cohort developed severe albuminuria (ie, macroalbuminuria). The cumulative 25-year incidence was markedly lower among people diagnosed in the 1980s than in the 1970s, at 12.0% versus 26.8%. However, the incidence did not fall further for those diagnosed in the 1990s, at 10.8%.

In people diagnosed in the 1970s, the incidence of severe albuminuria climbed rapidly to peak at 25.8 cases per 1000 person–years at 15–19 years after diabetes diagnosis, after which it fell to approximately 10 cases per 1000 person–years and remained there for the rest of the follow-up.

By contrast, people diagnosed in the 1980s and 1990s had a much slower increase in severe albuminuria incidence, which levelled out from around 14 years after diabetes diagnosis.

In line with the lower albuminuria incidence in more recently diagnosed people, the 30-year cumulative rate of kidney failure fell between the 1970s and 1980–1999, from 7.8% to 4.2%.

However, the likelihood of progressing to kidney failure did not decrease over time, with cumulative incidences of 35.2% at 15 years after onset of severe albuminuria for people diagnosed in the 1970s and 35.6% for those diagnosed in more recent years.

The author of a linked commentary, Bruce Perkins (Mount Sinai Hospital, Toronto, Ontario, Canada) observes that although many new treatments for both diabetes and renal disease became available over the study period, this “does not mean access for all.”

He adds: “Even in patients with severe albuminuria with reduced kidney function, the best evidence suggests a short-term postponement of kidney disease progression, rather than outright protection, from renin-angiotensin-system blockade.”

Perkins concludes: “As a community dedicated to transforming the lives of people with type 1 diabetes, we need to aggressively learn to implement more broadly our best strategies for glycaemic and metabolic control and get serious about the rapid evaluation of transformative renoprotective therapies already proven in type 2 diabetes.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Lancet Diabetes Endocrinol 2022; doi:10.1016/S2213-8587(22)00099-7
Lancet Diabetes Endocrinol 2022; doi:10.1016/S2213-8587(22)00132-2