Classification of longitudinal estimated glomerular filtration rate trajectories in Canadian adults with type 1 diabetes

• Published in: Journal of diabetes and its complications Vol. 38; no. 11; p. 108864
• Main Authors: Favel, Kristen, Bone, Jeffrey N., Elliott, Tom, Panagiotopoulos, Constadina, Mammen, Cherry
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2024; Elsevier Limited
• Subjects: Adults; Antihypertensives; Blood pressure; Body mass index; Chronic kidney disease; Clinical decision making; Clinical medicine; Clinical practice guidelines; Cohort analysis; Creatinine; Diabetes; Diabetic ketoacidosis; Diabetic neuropathy; Diabetic retinopathy; Estimated glomerular filtration rate; Glucose; Health risks; Hemodialysis; Hyperglycemia; Hypertension; Insulin; Kidney diseases; Patients; Renal replacement therapy; Statistical analysis; Transplants & implants; Type 1 diabetes; Urine; Variables; Canada; Type 1 diabetes; Estimated glomerular filtration rate; Chronic kidney disease
• ISSN: 1056-8727; 1873-460X; 1873-460X
• DOI: 10.1016/j.jdiacomp.2024.108864

Type 1 diabetes (T1D) increases the risk of chronic kidney disease (CKD) development. The aims of this study were to classify trajectories of estimated glomerular filtration rate (eGFR) in a cohort of Canadian adults with T1D, and to describe the risk factors associated with declining eGFR trajectories. In this retrospective cohort of adults with T1D, data was collected between 1996 and 2020. CKD was defined as eGFR <60 mL/min/1.73 m2. Latent class mixed models were used to categorize eGFR trajectories. Multinomial logistic regression was used to identify factors associated with declining eGFR trajectories. In this study, 304 adults were analyzed, with baseline measurements at a median duration of T1D of 15.3 (5.4–24.2) years. Eight percent of the cohort developed CKD over a median duration of 24.3 (13.7–34.8) years. Four classes of longitudinal eGFR trajectories were identified, broadly categorized as steeply declining (SD1, SD2) and gradual declining (GD1, GD2). Female sex, poor glycemic control, elevated body mass index, and albuminuria were associated with a steeply declining trajectory. In this cohort, four distinctive eGFR trajectories were identified, including a subtype with steeply declining eGFR. Given the complex nature of CKD progression, further prospective study of this model for identification of individuals at risk for CKD based on their trajectory of kidney function may support clinicians in their decision-making. •The effects of high blood sugar on the kidneys are complex.•People with type 1 diabetes are at risk for developing chronic kidney disease.•Early identification of those at risk for chronic kidney disease is advantageous.•Tracking change in kidney function may be a helpful tool for diabetes providers.