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Trajectory of Kidney Function in T1D over Time: A Scoping Review
Favian Co1, Reid Whitlock2, Arvind Katta3
1Seven Oaks General Hospital Chronic Disease Innovation Centre, 2LB19-2300 McPhillips St, Winnipeg, MB, R2V 3M3, Canada.
Summary
Type 1 diabetes (T1D) significantly increases the risk of chronic kidney disease (CKD) and major adverse cardiovascular events (MACE). Understanding kidney function decline in T1D is crucial for managing these risks and reducing healthcare costs.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Type 1 diabetes (T1D) is linked to chronic kidney disease (CKD) and major adverse cardiovascular events (MACE).
- Limited contemporary data exists on kidney function decline and treatment effects in T1D-related CKD.
- This scoping review examines the natural history of kidney function and its impact in US adults with T1D.
Purpose of the Study:
- To describe the natural trajectory of kidney function decline in individuals with T1D in the USA.
- To assess the impact of T1D on kidney function, cardiovascular events, and healthcare resource utilization.
- To inform the development of therapies for T1D-related CKD.
Main Methods:
- A scoping review of observational studies and grey literature was conducted.
- Searches included EMBASE, CINAHL, MEDLINE, Scopus, Global Health, and FDA databases up to April 25, 2025.
- Outcomes included changes in estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), MACE, and healthcare resource use (HCRU) in US adults with T1D.
Main Results:
- Over 50% of T1D individuals developed moderately increased albuminuria within 20 years.
- Annual eGFR decline averaged 3 mL/min/1.73 m² in T1D cohorts.
- T1D patients showed higher rates of MACE and kidney failure, with substantial annual healthcare costs ($17-27.8 billion total).
Conclusions:
- T1D imposes a significant burden of CKD, MACE, and high healthcare costs.
- Understanding kidney function decline trajectories in T1D is vital for evaluating therapeutic impacts.
- Improved insights can reduce risks of kidney failure, MACE, and healthcare resource use.
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