Prevalence and severity of chronic kidney disease in a population with type 1 diabetes from a United States health system: a real-world cohort study

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-05-15 DOI:10.1016/j.lana.2025.101130

Katherine R. Tuttle , Christina L. Reynolds , Lindsey M. Kornowske , Cami R. Jones , Radica Z. Alicic , Kenn B. Daratha , Joshua J. Neumiller , Carla Greenbaum , Meda E. Pavkov , Fang Xu , O. Kenrik Duru , Susanne B. Nicholas , Keith C. Norris , CURE-CKD Consortium

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Abstract

Background

A contemporary description and estimates for rates of chronic kidney disease (CKD) in type 1 diabetes are needed to inform risk reduction strategies. The study aim was to assess prevalence and severity of CKD based on a population with type 1 diabetes receiving care at a large United States health system.

Methods

Type 1 diabetes was identified through the Providence health system electronic health records during 2013–2022. Prevalent CKD was defined cross-sectionally by ≥ 90-day persistence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m², urine albumin-to-creatinine ratio ≥30 mg/g, or urine protein-to-creatinine ratio ≥0.15 g/g. Multivariable logistic regression models analyzed variable associations with CKD and severe kidney disease (eGFR < 45 mL/min/1.73 m², dialysis, or transplant).

Findings

The study population (N = 23,589) was 48.6% female with a mean ± SD age of 38 ± 17 years. CKD prevalence was 27.1%. Higher odds of CKD were found for females (odds ratio: 1.36 [95% confidence interval]: 1.26–1.47); age 60–79 years (reference 12–17 years; 2.22 [1.83–2.69]); Asian (reference White; 1.71 [1.20–2.44]), Black or African American (1.76 [1.45–2.14]), and Other race (1.33 [1.04–1.71]) populations. CKD odds were higher with hypertension, heart failure, and atherosclerotic cardiovascular disease. Severe kidney disease was present in 10.8% with higher odds among Black or African American (2.08 [1.23–3.54]) and Native Hawaiian or Pacific Islander (2.62 [1.28–5.38]) populations.

Interpretation

CKD was present in nearly one of three persons with type 1 diabetes with higher risks for females, older adults, racial and ethnic minorities, and those with cardiovascular diseases. Severe kidney disease was found in over one-tenth and more likely in Black or African American and Native Hawaiian or Pacific Islander populations. Focus on disproportionately affected groups who may benefit from monitoring and interventions to improve clinical outcomes will be important for public health and health system strategies to reduce risks of CKD and severe kidney disease in type 1 diabetes.

Funding

This work was supported in part by CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264, and in part by Brigham Research Institute.

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来自美国卫生系统的1型糖尿病人群中慢性肾脏疾病的患病率和严重程度：一项真实世界的队列研究

背景：需要对1型糖尿病中慢性肾脏疾病（CKD）的发生率进行当代描述和估计，以便为降低风险的策略提供信息。该研究的目的是评估在美国大型卫生系统中接受治疗的1型糖尿病患者CKD的患病率和严重程度。方法通过2013-2022年普罗维登斯卫生系统电子健康记录识别1型糖尿病。普遍慢性肾病的横断面定义为肾小球滤过率（eGFR）持续≥90天；60 mL/min/1.73 m2，尿白蛋白与肌酐比值≥30 mg/g，或尿蛋白与肌酐比值≥0.15 g/g。多变量logistic回归模型分析CKD和严重肾脏疾病(eGFR <；45ml /min/1.73 m2，透析或移植)。研究人群（N = 23,589）中女性占48.6%，平均±SD年龄为38±17岁。CKD患病率为27.1%。女性患CKD的几率较高（优势比：1.36[95%可信区间]:1.26-1.47）；年龄60-79岁(参考文献12-17岁；2.22 [1.83 - -2.69]);亚洲人(参考白人；1.71[1.20-2.44])，黑人或非裔美国人（1.76[1.45-2.14]），以及其他种族（1.33[1.04-1.71]）人口。高血压、心力衰竭和动脉粥样硬化性心血管疾病患者患CKD的几率更高。严重肾脏疾病发生率为10.8%，其中黑人或非裔美国人（2.08[1.23-3.54]）和夏威夷原住民或太平洋岛民（2.62[1.28-5.38]）的发病率更高。解释：近三分之一的1型糖尿病患者存在ckd，女性、老年人、少数种族和少数民族以及心血管疾病患者的风险较高。严重肾病的发病率超过十分之一，在黑人或非裔美国人、夏威夷原住民或太平洋岛民中发病率更高。关注可能受益于监测和干预以改善临床结果的不成比例的受影响群体，对于公共卫生和卫生系统战略降低1型糖尿病患者CKD和严重肾脏疾病的风险非常重要。本研究得到了美国疾病控制与预防中心项目75D301-21-P-12254和75D301-23-C-18264的部分支持，以及布莱根研究所的部分支持。

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Lancet Regional Health-Americas Multiple-

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8.00

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0.00%

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期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.