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Burden and Excess Risk of Adverse Outcomes in Patients With Type 1 Diabetes Using KDIGO Classification: A National Cohort Study
OBJECTIVE The widely adopted Kidney Disease: Improving Global Outcomes (KDIGO) classification system has been underused in assessing the burden and risk of adverse outcomes in type 1 diabetes. This observational study aimed to clarify how each KDIGO category correlates with adverse outcomes in this patient group. RESEARCH DESIGN AND METHODS In a cohort of 40,199 individuals with type 1 diabetes from the Swedish National Diabetes Register, we aimed to investigate the 1) prevalence of different KDIGO categories at base-line; within each category; and 3) association of baseline category with excess risk of five out-comes: a 40% decline in estimated glomerular filtration rate (eGFR), kidney failure, major adverse kidney/CV events, and all-cause mortality. Cox regression analyses were con-ducted using three different reference categories: 1) the conventional low-risk "combined G1A1 + G2A1"; 2) "G1A1" alone to assess whether G2A1 had excess risk; and 3) "G1bA1" alone to evaluate whether eGFR $105 mL/min/1.73 m2 had increased risk. RESULTS Among 39,067 included patients, with a mean follow-up of 9.1 years, 18.5% presented with chronic kidney disease (CKD), defined as eGFR <60 mL/min/1.73 m2 and/or albuminuria. A progressive increase in the incidence and adjusted hazard ratio for all studied outcomes was found with advancing eGFR and albuminuria categories, including in G2A1 (non-CKD). An eGFR $105 mL/min/1.73 m2 without albuminuria was not associated with increased risk. CONCLUSIONS A progressively increasing burden of all studied adverse outcomes was observed with advancing KDIGO categories. Even individuals with preserved eGFR and normoalbuminuria (G2A1), conventionally perceived as non-CKD, had an excess risk for all outcomes. © 2024 by the American Diabetes Association.
Authors : Makvandi K.; Eliasson B.; Carlsen H.K.; Baid-Agrawal S.
Source : American Diabetes Association Inc.
Article Information
| Year | 2025 |
| Type | Article |
| DOI | 10.2337/dc24-0908 |
| ISSN | 01495992 |
| Volume | 48 |
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