The Presence and Severity of Chronic Kidney Disease Predicts All-Cause Mortality in Type 1 Diabetes

• Published in: Diabetes (New York, N.Y.) Vol. 58; no. 7; pp. 1651 - 1658
• Main Authors: Groop, Per-Henrik, Thomas, Merlin C., Moran, John L., Wadèn, Johan, Thorn, Lena M., Mäkinen, Ville-Petteri, Rosengård-Bärlund, Milla, Saraheimo, Markku, Hietala, Kustaa, Heikkilä, Outi, Forsblom, Carol
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2009
• Subjects: Adolescent; Adult; Age of Onset; Biological and medical sciences; Blood pressure; Care and treatment; Cause of Death; Chronic kidney failure; Cohort Studies; Complications and side effects; Control; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - mortality; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - mortality; Diabetic Nephropathies - physiopathology; Diabetic nephropathy; Diagnosis; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Finland; Finland - epidemiology; Follow-Up Studies; Glomerular Filtration Rate; Hospitals; Humans; Insulin - therapeutic use; Kidney diseases; Kidneys; Male; Medical sciences; Middle Aged; Mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Original; Primary care; Questionnaires; Renal failure; Research design; Risk factors; Severity of Illness Index; Type 1 diabetes; Urinary system involvement in other diseases. Miscellaneous; Variables; Young Adult; Finland; Endocrinopathy; Kidney disease; Immunopathology; Urinary system disease; Type 1 diabetes; Mortality; Renal failure; Autoimmune disease; Chronic kidney disease
• ISSN: 0012-1797; 1939-327X; 1939-327X
• DOI: 10.2337/db08-1543

The Presence and Severity of Chronic Kidney Disease Predicts All-Cause Mortality in Type 1 Diabetes Per-Henrik Groop 1 , 2 , Merlin C. Thomas 3 , John L. Moran 4 , Johan Wadèn 1 , 2 , Lena M. Thorn 1 , 2 , Ville-Petteri Mäkinen 1 , 2 , Milla Rosengård-Bärlund 1 , 2 , Markku Saraheimo 1 , 2 , Kustaa Hietala 1 , 2 , 5 , Outi Heikkilä 1 , 2 and Carol Forsblom 1 , 2 on behalf of the FinnDiane Study Group 1 Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland; 2 Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Biomedicum Helsinki, Helsinki, Finland; 3 Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; 4 Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia; 5 Department of Ophthalmology, Jyväskylä Central Hospital, Jyväskylä, Finland. Corresponding author: Per-Henrik Groop, per-henrik.groop{at}helsinki.fi . Abstract OBJECTIVES This study aimed to identify clinical features associated with premature mortality in a large contemporary cohort of adults with type 1 diabetes. RESEARCH DESIGN AND METHODS The Finnish Diabetic Nephropathy (FinnDiane) study is a national multicenter prospective follow-up study of 4,201 adults with type 1 diabetes from 21 university and central hospitals, 33 district hospitals, and 26 primary health care centers across Finland. RESULTS During a median 7 years of follow-up, there were 291 deaths (7%), 3.6-fold (95% CI 3.2–4.0) more than that observed in the age- and sex-matched general population. Excess mortality was only observed in individuals with chronic kidney disease. Individuals with normoalbuminuria showed no excess mortality beyond the general population (standardized mortality ratio [SMR] 0.8, 95% CI 0.5–1.1), independent of the duration of diabetes. The presence of microalbuminuria, macroalbuminuria, and end-stage kidney disease was associated with 2.8, 9.2, and 18.3 times higher SMR, respectively. The increase in mortality across each stage of albuminuria was equivalent to the risk conferred by preexisting macrovascular disease. In addition, the glomerular filtration rate was independently associated with mortality, such that individuals with impaired kidney function, as well as those demonstrating hyperfiltration, had an increased risk of death. CONCLUSIONS An independent graded association was observed between the presence and severity of kidney disease and mortality in a large contemporary cohort of individuals with type 1 diabetes. These findings highlight the clinical and public health importance of chronic kidney disease and its prevention in the management of type 1 diabetes. Footnotes The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Received November 5, 2008. Accepted April 15, 2009. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details. © 2009 by the American Diabetes Association.