Burden and Excess Risk of Adverse Outcomes in Patients With Type 1 Diabetes Using KDIGO Classification: A National...

Area of Science:

• Nephrology
• Endocrinology
• Cardiovascular Medicine

Background:

• The Kidney Disease: Improving Global Outcomes (KDIGO) classification is widely used but its utility in type 1 diabetes for risk stratification requires further investigation.
• Assessing the full spectrum of adverse outcomes associated with KDIGO categories in type 1 diabetes is crucial for proactive patient management.

Purpose of the Study:

• To evaluate the correlation between KDIGO classification categories and the risk of adverse kidney and cardiovascular outcomes in individuals with type 1 diabetes.
• To determine the prevalence of different KDIGO categories and the incidence of adverse events within each category.

Main Methods:

• An observational study involving 40,199 individuals with type 1 diabetes from the Swedish National Diabetes Register.
• Cox regression analyses were used to assess the association between baseline KDIGO categories and outcomes including eGFR decline, kidney failure, major adverse kidney/cardiovascular events, and all-cause mortality.

Main Results:

• Among 39,067 participants, 18.5% had chronic kidney disease (CKD).
• A progressive increase in adverse outcomes and adjusted hazard ratios was observed with advancing KDIGO categories, including in the G2A1 (non-CKD) group.
• Elevated estimated glomerular filtration rate (eGFR) ≥105 mL/min/1.73 m2 without albuminuria did not show an increased risk.

Conclusions:

• Adverse outcome burden increases progressively with higher KDIGO classification categories in type 1 diabetes.
• Individuals categorized as G2A1 (normoalbuminuria, preserved eGFR), often considered non-CKD, exhibited an excess risk for all studied adverse outcomes.