Association between glycosylated hemoglobin level and 16-year incidence of chronic kidney disease in type 1 diabetes.

CONTEXT

The incidence of recently defined outcome of chronic kidney disease (CKD) has not been widely reported in type 1 diabetes.

OBJECTIVE

To examine the prospective association between baseline glycosylated hemoglobin levels and the 16-year incidence of CKD and end-stage renal disease (ESRD) in type 1 diabetes.

DESIGN

Prospective cohort study of type 1 diabetes individuals.

SETTING

Community based in southwestern Wisconsin.

PARTICIPANTS

547 younger-onset type 1 diabetes individuals who were free of CKD at baseline (1984-86).

MAIN OUTCOME MEASURES

Development of CKD (defined as estimated glomerular filtration rate<60 ml/min/1.73 m(2) or ESRD [history of dialysis or renal transplantation]) over 16-year follow-up period, among individuals free of CKD at baseline. Alternate outcome was 16-year incident ESRD.

RESULTS

After 16 years of follow-up, there were 158 cases of CKD and 37 cases of ESRD in our cohort. The 16-year cumulative incidence of CKD was 31.7 percent. Elevated glycosylated hemoglobin levels were associated with incident CKD and ESRD in separate models. Multivariable odds ratio (OR) [95% confidence intervals (CI)] comparing the highest quartile of glycosylated hemoglobin (11-15.3%) to the lowest quartile (6-8.6%) was 6.44 (3.61-11.51), p-trend<0.0001 for incident CKD and 21.87 (2.84-168.39), p-trend<0.0001 for ESRD.

CONCLUSIONS

Higher baseline glycosylated hemoglobin levels are independently associated with incident CKD and ESRD, among individuals with type 1 diabetes.