Chronic kidney disease in long duration type 1 diabetes lasting more than 50 years

ABSTRACT

Objective: There is evidence that microalbuminuria and overt nephropathy may progress more slowly in long duration (> 20 years) type 1 diabetes (T1DM). To explore this further, we examined the characteristics of chronic kidney disease (CKD) in a large cohort of long duration T1DM in the United Kingdom (UK).

Research design and methods: We studied the UK ‘Golden Years’ cohort – a group of 400 patients from various parts of the UK with T1DM > 50 years duration. Demographic and clinical information were obtained. HbA_1c, lipids, creatinine and urinary albumin-creatinine ratio (ACR) were measured. Microalbuminuria was defined as 2.5–25.0 mg/mmol for males and 3.5–25.0 mg/mmol for females; macroalbuminuria was defined as an ACR > 25.0 mg/mmol for both sexes.

Results: Mean age was 69 years and duration of diabetes 55 years. Nine percent had macroalbuminuria and 27% microalbuminuria. No patient had stage 5 CKD. Microalbuminuria was associated significantly with increased diabetes duration (p = 0.02), male sex (p = 0.02), smoking (p = 0.002), higher HbA_1c (p < 0.0001), raised triglycerides (p = 0.04), and peripheral vascular disease (PVD) (p < 0.0001). Macroalbuminuria had significant associations with smoking (p = 0.02), raised triglycerides (p = 0.01), raised creatinine (p = 0.02), PVD (p = 0.01) and hypertension (p = 0.01).

Conclusions: We conclude that microalbuminuria and CKD are common, even at long duration (> 50 years) of T1DM, and have similar characteristics and associations as they do with shorter disease duration. There is a striking absence, however, of stage 5 CKD, but selection bias may be an important confounder since patients with advanced disease may have not survived.

Key words: :

• Golden Years Cohort
• Kidney disease
• Nephropathy
• Type 1 diabetes

Acknowledgements

Declaration of interest: The ‘Golden Years Project’ was funded by Diabetes UK (Registered charity no. 215199; Diabetes UK is the operating name for The British Diabetic Association). The authors declare that they have no conflicts of interest with respect to the contents of this article.

The authors acknowledge Kay Jones (diabetes-specialist nurse, Arrowe Park Hospital, Wirral) and Carolyn Smith (diabetes-specialist nurse, birmingham heartlands hospital) for original data collection.