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Cumulative incidence of renal failure increases with longer type 1 diabetes duration

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SAN DIEGO — Duration of diabetes greatly affects the occurrence of advanced renal disease in older adults with type 1 diabetes, and decline in estimated glomerular filtration rate rather than genetics may help determine who is at risk later in life, a speaker said here.

“It’s become quite clear that we can anticipate that the cumulative incidence of nephropathy in type 1 diabetes doesn’t exceed 50%,” Trevor J. Orchard, MD, professor of epidemiology, medicine and pediatrics at the University of Pittsburgh Graduate School of Public Health and medical director of the nutrition lipid program, said during his presentation. “Given the lack of follow-up of longer durations and the poor survival in the earlier studies, we know little about the true long-term risk of nephropathy.”

Trevor J. Orchard

Orchard and colleagues evaluated data from the Pittsburgh Epidemiology of Diabetes Complications study cohort on 934 adults with type 1 diabetes (mean diabetes duration, 19 years) diagnosed between 1950 and 1980 to determine the cumulative risk for advanced renal disease over 50 years. A baseline exam was conducted between 1986 and 1988, and 146 participants had died before that period but were still included in the analysis. Periodic surveys were completed by 130 participants, and biennial surveys were completed by 658 participants over 25 years.

Participants were compared based on year of diabetes diagnosis: 1950 to 1964 (n = 390) and 1965 to 1980 (n = 542).

At 50 years, there was little difference in the cumulative incidence of renal failure, microalbuminuria and overt nephropathy among the two groups. The cumulative incidence of renal failure by 50 years of diabetes duration was nearly 60%, whereas it was 80% for overt nephropathy and 90% for microalbuminuria in both groups.

“Although we are reducing the progression of renal disease to the terminal state of renal failure needing renal replacement therapy, we are not succeeding in preventing the development of renal disease,” Orchard told Endocrine Today. “Indeed, the vast majority of those with type 1 diabetes will eventually get renal disease. We need more aggressive early intervention based on a better understanding of the early pathogenesis. We need to study, more closely, the interaction between genetic predisposition to renal disease and the established risk factors.” – by Amber Cox

Reference:

Orchard TJ, et al. 305-OR. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.

Disclosure: Orchard reports financial ties with Sanofi.