The Presence and Consequence of Nonalbuminuric Chronic Kidney Disease in Patients With Type 1 Diabetes

Abstract

OBJECTIVE This study investigated the prevalence of nonalbuminuric chronic kidney disease in type 1 diabetes to assess whether it increases the risk of cardiovascular and renal outcomes as well as all-cause mortality. RESEARCH DESIGN AND METHODS This was an observational follow-up of 3,809 patients with type 1 diabetes from the Finnish Diabetic Nephropathy Study. All patients were Caucasians and thoroughly examined at baseline. Their mean age was 37.6 ± 11.8 years and duration of diabetes 21.2 ± 12.1 years. Follow-up data on cardiovascular and renal outcomes and mortality were retrieved from registers. During 13 years of median follow-up, 378 developed end-stage renal disease, 415 suffered an incident cardiovascular event, and 406 died. RESULTS At baseline, 78 (2.0%) had nonalbuminuric chronic kidney disease. This was associated with older age, female sex, history of retinal laser treatment, cardiovascular events, and the number of antihypertensive drugs in use, but not with blood pressure levels or specific antihypertensive agents. Nonalbuminuric chronic kidney disease did not increase the risk of albuminuria (hazard ratio [HR] 2.0 [95% CI 0.9–4.4]) or end-stage renal disease (HR 6.4 [0.8–53.0]) but did increase the risk of cardiovascular events (HR 2.0 [1.4–3.5]) and all-cause mortality (HR 2.4 [1.4–3.9]). The highest risk of cardiovascular and renal end points was observed in the patients with albuminuria. CONCLUSIONS Nonalbuminuric chronic kidney disease is not a frequent finding in patients with type 1 diabetes, but when present, it is associated with an increased risk of cardiovascular morbidity and all-cause mortality but not with renal outcomes.

NGAL as an Early Predictive Marker of Diabetic Nephropathy in Children and Young Adults with Type 1 Diabetes Mellitus

“…In line with this, cohort studies, including prepubertal children with average diabetes duration of 5–8 years, revealed glomerular base membrane thickening and mesangial expansion [16], while they also disclosed that long-standing nonalbuminuric T1D participants might have significant glomerulopathy lesions [17–19, 21]. Moreover, the prevalence of nonalbuminuric CKD in T1D was recently reported to be 2% and was associated with a higher risk of cardiovascular morbidity as well as all-cause mortality in people with T1D [4, 5]. …”

“…Thus, it represents a significant burden to the patients and the society they live in [2, 3]. Moreover, nonalbuminuric DN has been reported to have a prevalence of 2% among people with T1D and chronic kidney disease (CKD) [4, 5]. …”

Diabetic nephropathy in type 1 diabetes: a review of early natural history, pathogenesis, and diagnosis

“…Up to 20% of patients with type 2 diabetes already have diabetic kidney disease when diagnosed with diabetes and a further 30% to 40% develop DN, mostly within 10 years of diagnosis . Nonalbuminuric DN is less studied, but a recent study from Finland reported that 2% of patients with T1D had nonalbuminuric CKD …”

Prevalence of nephropathy in type 1 diabetes in the Arab world: A systematic review and meta‐analysis

“…Full‐text articles were screened to capture the relevant data for patients with T1D who had DN without age limits (Table ). Our inclusion criteria were as follows: Article was published as a peer‐reviewed research article, patients developed DN as a complication of T1D only, patients were of Arab ethnicity and lived in Arab countries, and patients developed nephropathy as measured by microalbuminuria or macroalbuminuria or by reduced glomerular filtration rate. Our exclusion criteria were as follows: It was unclear whether patients developed nephropathy because of T1D or T2D, nephropathy resulted from T2D only, the type of diabetes was not mentioned in the study, lack of random selection of the T1D subjects, and publication in a language other than English.…”

“…However, recent studies showed that DN, in some cases, begins prior to the onset of albuminuria. In addition, it has been reported that some of patients with T1D had nonalbuminuric nephropathy . Therefore, several studies have proposed the use of new phenotypes such as the early renal function decline together with MA …”