Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
Can J Diabetes. 2022 Jul;46(5):457-463.e1. doi: 10.1016/j.jcjd.2022.01.007. Epub 2022 Jan 31.
Type 1 diabetes (T1D) increases the risk of chronic kidney disease (CKD) development. The primary objective of this study was to assess the prevalence of abnormalities in estimated glomerular filtration rate (eGFR) in children with T1D. As a secondary objective, we sought to explore the relationship between clinical characteristics and abnormalities in eGFR.
This cross-sectional study involved children ≤18 years of age with T1D followed in the diabetes clinic at a pediatric tertiary care centre. Data were collected from health records between 2016 and 2020. Using the Bedside Schwartz, Chronic Kidney Disease in Children Under 25 (CKiD U25) and European Kidney Function Consortium (EKFC) equations, eGFR was categorized as CKD (<60 mL/min/1.73 m), mildly decreased (60 to <90 mL/min/1.73 m), normal (90 to <158 mL/min/1.73 m) and hyperfiltration (≥158 mL/min/1.73 m). Linear regression analysis was used to describe the relationship between eGFR and clinical characteristics.
Of the 420 participants, 225 were male (54%); the median age at diagnosis and duration of T1D were 6.1 and 4.8 years, respectively. The proportion of participants with mildly decreased eGFR was similar regardless of eGFR equation, with 11% to 14% of participants with an eGFR <90 mL/min/1.73 m. When analyzed as a function of duration of T1D, eGFR was 1.4 mL/min/1.73 m lower per year duration of T1D.
A notable proportion of children with T1D demonstrates eGFR abnormalities early in their T1D course. This finding along with evidence of lower eGFR in adolescence is concerning for long-term risk of CKD and warrants systematic serum creatinine monitoring at diagnosis and regular intervals thereafter in children with T1D.
1 型糖尿病（T1D）会增加慢性肾脏病（CKD）发展的风险。本研究的主要目的是评估 T1D 儿童肾小球滤过率估计值（eGFR）异常的发生率。作为次要目标，我们试图探讨临床特征与 eGFR 异常之间的关系。
这是一项横断面研究，纳入了在儿科三级保健中心糖尿病诊所就诊的≤18 岁 T1D 儿童。研究数据来自 2016 年至 2020 年的健康记录。使用床边 Schwartz、25 岁以下儿童慢性肾脏病（CKiD U25）和欧洲肾脏功能联合会（EKFC）方程，将 eGFR 分为 CKD（<60 mL/min/1.73 m）、轻度降低（60 至<90 mL/min/1.73 m）、正常（90 至<158 mL/min/1.73 m）和高滤过（≥158 mL/min/1.73 m）。线性回归分析用于描述 eGFR 与临床特征之间的关系。
在 420 名参与者中，225 名男性（54%）；诊断时的中位年龄和 T1D 病程分别为 6.1 岁和 4.8 年。无论使用哪种 eGFR 方程，eGFR 轻度降低的参与者比例相似，有 11%至 14%的参与者 eGFR<90 mL/min/1.73 m。当按 T1D 病程分析时，T1D 病程每延长 1 年，eGFR 会降低 1.4 mL/min/1.73 m。
相当一部分 T1D 儿童在 T1D 病程早期就出现 eGFR 异常。这一发现以及青春期 eGFR 降低的证据表明，T1D 儿童存在长期 CKD 风险，需要在诊断时以及此后定期进行系统性血清肌酐监测。
