Trajectory of Kidney Function in T1D over Time: A Scoping Review.

IF 4.2 3区医学 Q2 Medicine

Diabetes Therapy Pub Date : 2026-09-01 Epub Date: 2026-07-15 DOI:10.1007/s13300-026-01899-9

Favian Co, Reid Whitlock, Arvind Katta, Carolina Aldworth, Jon Mares, Zihe Zheng, Mauricio Ferri, Nicole Askin, Navdeep Tangri

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引用次数: 0

Abstract

Introduction: Type 1 diabetes (T1D) is associated with chronic kidney disease (CKD) and major adverse cardiovascular events (MACE). Contemporary data on the natural history of kidney function decline and the effect of therapies on slowing disease progression in T1D-related CKD are limited. We conducted a scoping review to describe the natural trajectory of kidney function and its effects in individuals with T1D in the USA.

Methods: In our scoping review of observational studies and grey literature, we searched EMBASE (Ovid), Cumulative Index to Nursing and Allied Health Literature [CINAHL; Elton B. Stephens Company (EBSCO)], MEDLINE (Ovid), Scopus (Elsevier), Global Health (Ovid), and the Food and Drug Administration from inception to 25 April 2025. The study population included adults (age ≥ 18 years) with T1D in the USA. Our outcomes were change in estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), MACE (myocardial infarction, ischemic stroke, cardiovascular death, unstable angina, or heart failure hospitalization), and healthcare resource use (HCRU). We screened 6437 abstracts and selected 22 texts that matched our criteria.

Results: In one cohort, more than 50.0% of individuals with T1D developed moderately increased albuminuria (UACR > 30-299 mg/g) after 20 years and two cohort studies in T1D observed a progressive annual eGFR decline of 3 mL/min/1.73 m². Five cohort studies found higher proportions of individuals with T1D experienced MACE or kidney failure versus those without T1D. Cross-sectional studies estimated total annual cost of HCRU in the USA at $17-27.8 billion for those with T1D, with annual per-patient costs ranging from $73,534-$112,833 for kidney failure and $40,889-$86,417 for components of MACE.

Conclusions: T1D is associated with a high burden of CKD, MACE, and healthcare costs. A clearer understanding of the trajectory of kidney function decline in T1D would help providers and policymakers understand the impact potential therapies to treat T1D-related CKD may have on reducing the risk of kidney failure, MACE, and HCRU.

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T1D患者肾功能随时间的变化轨迹：范围综述。

1型糖尿病（T1D）与慢性肾脏疾病（CKD）和主要不良心血管事件（MACE）相关。在t1d相关的CKD中，肾功能下降的自然史和治疗对减缓疾病进展的影响的当代数据是有限的。我们进行了一项范围综述，以描述美国T1D患者肾脏功能的自然轨迹及其影响。方法：在我们的观察性研究和灰色文献的范围综述中，我们检索了EMBASE （Ovid）、护理和相关健康文献累积指数(CINAHL；Elton B. Stephens Company (EBSCO), MEDLINE (Ovid), Scopus (Elsevier), Global Health （Ovid）和Food and Drug Administration，从成立到2025年4月25日。研究人群包括美国患有T1D的成年人（年龄≥18岁）。我们的研究结果是肾小球滤过率（eGFR）、尿白蛋白与肌酐比值（UACR）、MACE（心肌梗死、缺血性卒中、心血管死亡、不稳定型心绞痛或心力衰竭住院）和医疗资源使用（HCRU）的变化。我们筛选了6437篇摘要，从中选择了22篇符合我们标准的文章。结果：在一个队列中，超过50.0%的T1D患者在20年后出现中度蛋白尿增加（UACR bb0 30-299 mg/g），两个T1D队列研究观察到eGFR每年进行性下降3 mL/min/1.73 m2。五项队列研究发现，与非T1D患者相比，T1D患者经历MACE或肾衰竭的比例更高。横断面研究估计，美国T1D患者HCRU的年总成本为170 - 278亿美元，肾衰竭患者的年人均成本为73,534- 112,833美元，MACE组件的年人均成本为40,889- 86,417美元。结论：T1D与CKD、MACE和医疗费用的高负担有关。更清楚地了解T1D患者肾功能下降的轨迹，将有助于提供者和决策者了解治疗T1D相关CKD的潜在疗法对降低肾衰竭、MACE和HCRU风险的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.90

自引率

7.90%

发文量

130

审稿时长

6 weeks

期刊介绍： Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.