The early decline in renal function in patients with type 1 diabetes and proteinuria predicts the risk of end-stage renal disease

Abstract

The risk of end-stage renal disease (ESRD) remains high in patients with type 1diabetes and proteinuria; however, little is known about the rate of decline in their renal function. To help determine this we enrolled patients with 1 diabetes and proteinuria whose estimated glomerular filtration rate (eGFR) was normal (equal to or above 60 ml/min/1.73m2). Using a minimum of 5 serial measurements of serum creatinine for 161 patients, we determined individual trajectories of eGFR change and the occurrence of ESRD during 5–18 years of follow-up. The rates were linear for 110 patients, for 24 the non-linear rate was mild enough to satisfy a linear model, and the rates were clearly non-linear for only 27 patients. Overall, in more than one third of patients, the eGFR decline was less than 3.5 ml/min/1.73m2 per year and the lifetime risk of ESRD could be considered negligible. In the remainder of patients, eGFR declined with widely different slopes and ESRD developed within 2 to 18 years. Based on up to five years observation when renal function was within the normal range, the estimates of early eGFR slope predicted the risk of ESRD during subsequent follow-up better than the baseline clinical characteristics of glycated hemoglobin, blood pressure, or the albumin to creatinine ratio. Thus, the early slope of eGFR decline in patients with type 1diabetes and proteinuria can be used to predict the risk of ESRD.

Blood Kidney Injury Molecule-1 Is a Biomarker of Acute and Chronic Kidney Injury and Predicts Progression to ESRD in Type I Diabetes

“…The statistical methods used to analyze the follow-up data from the Joslin proteinuria cohort have been described previously. 23 …”

“…During follow-up they had serial serum creatinine measurements to estimate the rate of renal decline rate of eGFR loss (eGFR slopes) according to methods previously described. 23 All human studies were approved by institutional review boards.…”

Diabetic Nephropathy

“…For others, their decline in renal function is so rapid that they can progress from normal renal function to ESRD within as few as 2-5 years. 6 These studies have begun to reshape our perception of the natural course of diabetic nephropathy and have implications for etiological studies as well as the development of intervention programs. 7 They also have profound implications on genetic studies of diabetic nephropathy while raising several important questions that have yet to be answered.…”

“…Furthermore, this decline varies widely among patients with type 1 diabetes. 6 For some patients, renal function declines so slowly that ESRD might be reached only after 30 to 50 years of diabetes. For others, their decline in renal function is so rapid that they can progress from normal renal function to ESRD within as few as 2-5 years.…”

Diabetes and renal disease: who does what?

“…11 In the current study, it would appear that deterioration of renal function does not influence patterns of referral. From our data, the same proportion of patients classified as progressors was seen in each of the three follow-up groups (primary care, diabetes and nephrology).…”