Cumulative Risk, Age at Onset, and Sex-Specific Differences for Developing End-Stage Renal Disease in Young Patients With Type 1 Diabetes

Abstract

OBJECTIVEThis study aimed to estimate the current cumulative risk of end-stage renal disease (ESRD) due to diabetic nephropathy in a large, nationwide, population-based prospective type 1 diabetes cohort and specifically study the effects of sex and age at onset.RESEARCH DESIGN AND METHODSIn Sweden, all incident cases of type 1 diabetes aged 0–14 years and 15–34 years are recorded in validated research registers since 1977 and 1983, respectively. These registers were linked to the Swedish Renal Registry, which, since 1991, collects data on patients who receive active uremia treatment. Patients with ≥13 years duration of type 1 diabetes were included (n = 11,681).RESULTSDuring a median time of follow-up of 20 years, 127 patients had developed ESRD due to diabetic nephropathy. The cumulative incidence at 30 years of type 1 diabetes duration was low, with a male predominance (4.1% [95% CI 3.1–5.3] vs. 2.5% [1.7–3.5]). In both male and female subjects, onset of type 1 diabetes before 10 years of age was associated with the lowest risk of developing ESRD. The highest risk of ESRD was found in male subjects diagnosed at age 20–34 years (hazard ratio 3.0 [95% CI 1.5–5.7]). In female subjects with onset at age 20–34 years, the risk was similar to patients' diagnosed before age 10 years.CONCLUSIONSThe cumulative incidence of ESRD is exceptionally low in young type 1 diabetic patients in Sweden. There is a striking difference in risk for male compared with female patients. The different patterns of risk by age at onset and sex suggest a role for puberty and sex hormones.

Predictors of diabetic nephropathy

“…During the follow-up period, 127 patients developed ESRD secondary to DN. In both genders, the onset of type 1 DM before 10 years of age was associated with a reduced risk of developing DN [15], going in line with findings of earlier studies [16][17][18][19][20][21][22]. The reason explaining this age dependent effect is not clear yet.…”

“…Experiments done in mice were successful in identifying estrogens as an important factor retarding the progression of kidney disease [12,13], in contrast to testosterone that aggravates it [14]. Intrigued with such findings, a recent study by Möllsten et al investigated the elements of gender and age as risk factors of CKD progression in patients with type 1 diabetes [15]. The study was a large, nationwide, population-based cohort study done in Sweden with a median follow-up period of 20 years [15].…”

“…Intrigued with such findings, a recent study by Möllsten et al investigated the elements of gender and age as risk factors of CKD progression in patients with type 1 diabetes [15]. The study was a large, nationwide, population-based cohort study done in Sweden with a median follow-up period of 20 years [15]. It included 11,681 type 1 diabetic patients, with diabetes duration of more than 13 years.…”

“…It included 11,681 type 1 diabetic patients, with diabetes duration of more than 13 years. It utilized validated research registers (1977)(1978)(1979)(1980)(1981)(1982)(1983) that were connected to the Swedish Renal Registry [15]. During the follow-up period, 127 patients developed ESRD secondary to DN.…”

Dyslipidemia in young patients with type 1 diabetes mellitus

“…Better GC is associated with improved survival in patients with T1D, leading to progressive changes in the causes of mortality, particularly cardiovascular disease; therefore, it is important to identify the risk factors for cardiovascular disease in this population (25)(26)(27)(28)(29)(30)(31).…”