Variations in Risk of End-Stage Renal Disease and Risk of Mortality in an International Study of Patients With Type 1 Diabetes and Advanced Nephropathy

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Skupien , J , Smiles , A M , Valo , E , Ahluwalia , T S , Gyorgy , B , Sandholm , N , Croall , S , Lajer , M , McDonnell , K , Forsblom , C , Harjutsalo , V , Marre , M , Galecki , A T , Tregouet , D-A , Wu , C Y , Mychaleckyj , J C , Nickerson , H , Pragnell , M , Rich , S S , Pezzolesi , M G , Hadjadj , S , Rossing , P , Groop , P-H & Krolewski , A S 2019 , ' Variations in Risk of End-Stage Renal Disease and Risk of Mortality in an International Study of Patients With Type 1 Diabetes and Advanced Nephropathy ' , Diabetes Care , vol. 42 , no. 1 , pp. 93-101 . https://doi.org/10.2337/dc18-1369

Title: Variations in Risk of End-Stage Renal Disease and Risk of Mortality in an International Study of Patients With Type 1 Diabetes and Advanced Nephropathy
Author: Skupien, Jan; Smiles, Adam M.; Valo, Erkka; Ahluwalia, Tarunveer S.; Gyorgy, Beata; Sandholm, Niina; Croall, Stephanie; Lajer, Maria; McDonnell, Kevin; Forsblom, Carol; Harjutsalo, Valma; Marre, Michel; Galecki, Andrzej T.; Tregouet, David-Alexandre; Wu, Chun Yi; Mychaleckyj, Josyf C.; Nickerson, Helen; Pragnell, Marlon; Rich, Stephen S.; Pezzolesi, Marcus G.; Hadjadj, Samy; Rossing, Peter; Groop, Per-Henrik; Krolewski, Andrzej S.
Contributor: University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Research Programs Unit
University of Helsinki, Research Programs Unit
University of Helsinki, Research Programs Unit
Date: 2019-01-01
Language: eng
Number of pages: 9
Belongs to series: Diabetes Care
ISSN: 0149-5992
URI: http://hdl.handle.net/10138/288713
Abstract: OBJECTIVE Patients with type 1 diabetes and diabetic nephropathy are targets for intervention to reduce high risk of end-stage renal disease (ESRD) and deaths. This study compares risks of these outcomes in four international cohorts. RESEARCH DESIGN AND METHODS In the 1990s and early 2000s, Caucasian patients with type 1 diabetes with persistent macroalbuminuria in chronic kidney disease stages 1-3 were identified in the Joslin Clinic (U. S., 432), Finnish Diabetic Nephropathy Study (FinnDiane) (Finland, 486), Steno Diabetes Center Copenhagen (Denmark, 368), and INSERM (France, 232) and were followed for 3-18 years with annual creatinine measurements to ascertain ESRD and deaths unrelated to ESRD. RESULTS During 15,685 patient-years, 505 ESRD cases (rate 32/1,000 patient-years) and 228 deaths unrelated to ESRD (rate 14/1,000 patient-years) occurred. Risk of ESRD was associated with male sex; younger age; lower estimated glomerular filtration rate (eGFR); higher albumin/creatinine ratio, HbA1c, and systolic blood pressure; and smoking. Risk of death unrelated to ESRD was associated with older age, smoking, and higher baseline eGFR. In adjusted analysis, ESRD risk was highest in Joslin versus reference FinnDiane (hazard ratio [HR] 1.44, P = 0.003) and lowest in Steno (HR 0.54, P <0.001). Differences in eGFR slopes paralleled risk of ESRD. Mortality unrelated to ESRD was lowest in Joslin (HR 0.68, P = 0.003 vs. the other cohorts). Competing risk did not explain international differences in the outcomes. CONCLUSIONS Despite almost universal renoprotective treatment, progression to ESRD and mortality in patients with type 1 diabetes with advanced nephropathy are still very high and differ among countries. Finding causes of these differences may help reduce risk of these outcomes.
Subject: ALL-CAUSE MORTALITY
CARDIOVASCULAR MORTALITY
KIDNEY-FUNCTION
FOLLOW-UP
DECLINE
PREDICTS
DETERIORATION
PROTEINURIA
PATTERNS
ONSET
3121 General medicine, internal medicine and other clinical medicine
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