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

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.

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.

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.

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.