Risk for kidney function loss elevated for African Caribbean adults with type 1 diabetes
Click Here to Manage Email Alerts
African Caribbean adults with type 1 diabetes have a higher risk for kidney function loss than those of other ethnicities, according to study findings published in Diabetes Care.
“We made the novel observation that people with type 1 diabetes of African Caribbean ethnicity had a nearly 60% increased risk of significant kidney function loss,” Janaka Karalliedde, FRCP, PhD, clinical reader in diabetes and cardiovascular disease in the School of Cardiovascular and Metabolic Medicine & Sciences at King’s College London, told Healio. “This loss of kidney function was independent of conventional risk factors for kidney disease and also occurred faster in people with type 1 diabetes of African Caribbean ethnicity.”
Karalliedde and colleagues collected data from 5,261 adults with type 1 diabetes who underwent surveillance diabetes eye screening in southeast London from 2004 to 2018 (median age, 34 years; 49.3% men; mean duration of diabetes, 11 years). Clinical and biochemical data were collected from electronic medical records. Serum creatinine measurements were used to calculate estimated glomerular filtration rate. The primary endpoint was a 50% or greater reduction in eGFR from baseline with a final value of less than 30 mL/min/1.73 m2 confirmed on repeat testing. Secondary endpoints of a 30% and 40% reduction in eGFR were also analyzed.
Of the cohort, 77.8% were white, 13.4% were African Caribbean, 2.9% were Asian and 5.9% were from other ethnicities. The median eGFR at baseline was 90.7 mL/min/1.73 m2 and the median follow-up was 8 years.
Of the full cohort, 5% had an eGFR decline of 50% or more from baseline with a final eGFR of less than 30 mL/min/1.73 m2. In a multivariable model, African Caribbean adults had a higher risk for an eGFR decline of greater than 50% compared with other ethnicities (adjusted HR = 1.57; 95% CI, 1.19-2.08; P < .001). African Caribbean adults also had a higher risk for an eGFR decline of at least 40% (aHR = 1.56; 95% CI, 1.19-2.05; P = .001) and an eGFR decline of at least 30% (aHR = 1.61; 95% CI, 1.23-2.11; P = .001) compared with other adults.
The incidence rate for an eGFR decline of 50% or higher was 8.8 per 1,000 patient-years of follow-up in the full study cohort. The incidence rate was more than twice as high among African Caribbean adults compared with adults who were not of African Caribbean ethnicity (16 vs. 7.7 per 1,000 patient-years; P < .001).
End-stage renal disease was observed in 2.3% of the study cohort. The incidence rate for ESRD was more than three times higher in African Caribbean adults compared with all other ethnicities (8 vs. 2.6 per 1,000 patient-years; P < .001).
"These results were not a total surprise to my colleagues and I who have been looking after people with type 1 diabetes and advanced kidney disease in London for many years,” Karalliedde said. “We have observed that there is a higher and disproportionate number of people of ‘non-Caucasian’ ethnicity who present with kidney failure and other vascular complications of type 1 diabetes. The results from this research confirm these clinical observations and experience and are important as they will help guide future research to understand the exact reasons for this higher risk.”
Karalliedde said more research is needed to analyze the mechanisms and potential risk factors of reduced kidney function among African Caribbean adults.
For more information:
Janaka Karalliedde, FRCP, PhD, can be reached at j.karalliedde@kcl.ac.uk.
Collapse
Read more about
Click Here to Manage Email Alerts