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Non-albuminuric CKD increases CV, all-cause mortality risk in adults with type 1 diabetes
Adults with type 1 diabetes and non-albuminuric chronic kidney disease have an increased risk for both cardiovascular events and all-cause death, but no increased risk for albuminuria or end-stage renal disease, according to research in Diabetes Care.
In an observational follow-up study of more than 3,800 Finnish patients with type 1 diabetes, researchers also found that non-albuminuric CKD was rarer than what is typically seen in patients with type 2 diabetes, and that the highest risk for CV events or renal disease was seen in patients with type 1 diabetes and albuminuria.
“A novel finding was that non-albuminuric CKD increased the risk of [CV] morbidity and all-cause mortality to the same extent as albuminuric non-CKD, but did not increase the risk of renal outcomes in type 1 diabetes,” the researchers wrote. “The highest risk of the outcomes studied was observed in the patients with albuminuric CKD.”
Lena N. Thorn, MD, DMSc , of the Folkhälsan Institute of Genetics at the Folkhälsan Research Center in Helsinki, and colleagues analyzed data from 3,809 white adults (mean age, 37.6 years; duration of diabetes, 21.2 years) with type 1 diabetes participating in the Finnish Diabetic Nephropathy Study. Using Finnish hospital discharge records and death records, researchers obtained data on ESRD and CV events, including myocardial infarction, coronary revascularization, stroke or CV death.
Within the cohort, researchers found that 502 adults had CKD; 78 of those adults (2%) had non-albuminuric CKD. Patients with non-albuminuric CKD were more often female, older and had type 1 diabetes for a longer period of time; they also had lower blood pressure, better glycemic control, and were less likely to have a history of retinal laser treatments and history of using antihypertensive medications.
Researchers found that non-albuminuric CKD did not increase the risk of developing albuminuria (HR = 2; 95% CI, 0.9-4.4) or ESRD (HR = 6.4; 95% CI, 0.8-53), but risk did increase significantly in patients with albuminuric CKD (HR = 220.7; 95% CI, 99.5-489.2).
The risk of developing CV events increased in patients with non-albuminuric CKD (HR = 2; 95% CI, 1.4-3.5), as did the risk for all-cause mortality (HR = 2.4; 95% CI, 1.4-3.9).
“Whether non-albuminuric CKD is true diabetic nephropathy or not, our study indicates that it is associated with a more favorable prognosis regarding renal disease progression but nonetheless increases the risk of [CV] outcomes and all-cause mortality in these patients,” the researchers wrote. – by Regina Schaffer
Disclosure: One of the researchers reports receiving speaker honorariums from or serving as an advisory board member for Boehringer Ingelheim, Cebix, Eli Lilly, Genzyme Oy, Medscape, MSD, Novartis and Novo Nordisk. Thorn and the other researchers report no relevant financial disclosures.