Kidney Disease Risk in Type 1 Diabetes Tied to Blood Pressure, Glucose Levels

Diabetic kidney disease is potentially one of the most disabling complications of diabetes. It can sap your energy, and eventually often requires regular dialysis treatments that can keep you alive, but may not leave you feeling much better.

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People with type 1 diabetes have long been considered at higher risk for kidney disease, along with other diabetes complications, due to the longer duration of the disease they often experience. For a new study, researchers decided to dig into the factors that may affect whether people with type 1 diabetes start to develop kidney dysfunction.

Published last week in the Journal of Diabetes and its Complications, the study involved 3,940 participants with type 1 diabetes. At the beginning of the study, their average age was 41, with an average diabetes duration of 21 years. All of them had normal blood and urine markers of kidney function at first, and they had their clinical data collected for the study over the next 5 years.

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The researchers defined adverse kidney outcomes during the follow-up period based on two different measurements: an eGFR (a blood test measuring kidney function) lower than 60 ml/min, or albuminuria (the presence of a protein called albumin in your urine) in two consecutive measurements, or two out of the past three.

During the follow-up period, 17% of participants experienced an adverse kidney outcome. The researchers looked at a variety of factors in an effort to find out whether they predicted worsened kidney function — both in the participants’ clinical data, and in questions they answered when they became study participants. They found a number of factors that were associated with worse kidney outcomes.

As noted in a Healio article on the study, older participants were more likely to develop adverse kidney outcomes — the average age of those who went on to develop albuminuria was 55, and it was 53 for those whose eGFR dropped too low. Participants with these outcomes were also more likely to have been diagnosed with diabetes under the age of 19.

But age and diabetes duration weren’t the only predictors of kidney outcomes. The average HbA1c level of participants who developed albuminuria during the follow-up period was 8.1%, and it was 7.9% for those with a too-low eGFR — compared with 7.6% for participants who didn’t have adverse kidney outcomes. Average systolic blood pressure was also slightly higher in the albuminuria and low eGFR groups: 125 mmHg and 123 mmHg, versus 122 mmHg for those with normal kidney function.

Participants with worse kidney function were also less likely to use a continuous glucose monitoring (CGM) system, with 47% using it compared with 56% of those with normal kidney function. They were also less likely to have a bachelor’s degree or higher education level, at 50%, than those with normal kidney function, at 63%.

The researchers concluded that the findings on HbA1c serve as a “reminder that glucose control across the life span continues to be an important factor in the development of diabetes complications, and that poor metabolic control early in the disease may have long-term consequences.”

Want to learn more about maintaining your kidney health? Read “Kidney Disease: Your Seven-Step Plan for Prevention,” “Ten Things to Know About Kidney Disease” and “Protecting Your Kidneys.”

Quinn PhillipsQuinn Phillips

A freelance health writer and editor based in Wisconsin, Phillips has a degree in government from Harvard University. He writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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