Tuttle Katherine R, Reynolds Christina L, Kornowske Lindsey M, Jones Cami R, Alicic Radica Z, Daratha Kenn B, Neumiller Joshua J, Greenbaum Carla, Pavkov Meda E, Xu Fang, Duru O Kenrik, Nicholas Susanne B, Norris Keith C
Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA.
Nephrology Division and Kidney Research Institute, University of Washington School of Medicine, Seattle, WA, USA.
Lancet Reg Health Am. 2025 May 15;47:101130. doi: 10.1016/j.lana.2025.101130. eCollection 2025 Jul.
A contemporary description and estimates for rates of chronic kidney disease (CKD) in type 1 diabetes are needed to inform risk reduction strategies. The study aim was to assess prevalence and severity of CKD based on a population with type 1 diabetes receiving care at a large United States health system.
Type 1 diabetes was identified through the Providence health system electronic health records during 2013-2022. Prevalent CKD was defined cross-sectionally by ≥ 90-day persistence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m, urine albumin-to-creatinine ratio ≥30 mg/g, or urine protein-to-creatinine ratio ≥0.15 g/g. Multivariable logistic regression models analyzed variable associations with CKD and severe kidney disease (eGFR < 45 mL/min/1.73 m, dialysis, or transplant).
The study population (N = 23,589) was 48.6% female with a mean ± SD age of 38 ± 17 years. CKD prevalence was 27.1%. Higher odds of CKD were found for females (odds ratio: 1.36 [95% confidence interval]: 1.26-1.47); age 60-79 years (reference 12-17 years; 2.22 [1.83-2.69]); Asian (reference White; 1.71 [1.20-2.44]), Black or African American (1.76 [1.45-2.14]), and Other race (1.33 [1.04-1.71]) populations. CKD odds were higher with hypertension, heart failure, and atherosclerotic cardiovascular disease. Severe kidney disease was present in 10.8% with higher odds among Black or African American (2.08 [1.23-3.54]) and Native Hawaiian or Pacific Islander (2.62 [1.28-5.38]) populations.
CKD was present in nearly one of three persons with type 1 diabetes with higher risks for females, older adults, racial and ethnic minorities, and those with cardiovascular diseases. Severe kidney disease was found in over one-tenth and more likely in Black or African American and Native Hawaiian or Pacific Islander populations. Focus on disproportionately affected groups who may benefit from monitoring and interventions to improve clinical outcomes will be important for public health and health system strategies to reduce risks of CKD and severe kidney disease in type 1 diabetes.
This work was supported in part by CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264, and in part by Brigham Research Institute.
需要对1型糖尿病患者慢性肾脏病（CKD）的现状进行描述并估算其发病率，以便为风险降低策略提供依据。本研究旨在评估在美国一家大型医疗系统接受治疗的1型糖尿病患者群体中CKD的患病率和严重程度。
通过普罗维登斯医疗系统2013 - 2022年的电子健康记录识别1型糖尿病患者。将估算肾小球滤过率（eGFR）持续≥90天＜60 mL/（min·1.73 m²）、尿白蛋白与肌酐比值≥30 mg/g或尿蛋白与肌酐比值≥0.15 g/g定义为CKD。多变量逻辑回归模型分析与CKD和严重肾病（eGFR＜45 mL/（min·1.73 m²）、透析或移植）相关的变量。
研究人群（N = 23589）中女性占48.6%，平均年龄±标准差为38±17岁。CKD患病率为27.1%。女性患CKD的几率更高（优势比：1.36[95%置信区间]：1.26 - 1.47）；年龄在60 - 79岁（参考年龄12 - 17岁；2.22[1.83 - 2.69]）；亚洲人（参考白人；1.71[1.20 - 2.44]）、黑人或非裔美国人（1.76[1.45 - 2.14]）以及其他种族（1.33[1.04 - 1.71]）人群。患有高血压、心力衰竭和动脉粥样硬化性心血管疾病的患者患CKD的几率更高。10.8%的患者患有严重肾病，其中黑人或非裔美国人（2.08[1.23 - 3.54]）以及夏威夷原住民或太平洋岛民（2.62[1.28 - 5.38]）人群患病几率更高。
近三分之一的1型糖尿病患者患有CKD，女性、老年人、少数族裔以及患有心血管疾病的患者患病风险更高。超过十分之一的患者患有严重肾病，黑人或非裔美国人以及夏威夷原住民或太平洋岛民人群患病可能性更大。关注那些可能从监测和干预中受益以改善临床结局的受影响尤为严重的群体，对于公共卫生和卫生系统降低1型糖尿病患者CKD和严重肾病风险的策略至关重要。
本研究部分得到美国疾病控制与预防中心项目编号75D301 - 21 - P - 12254和75D301 - 23 - C - 18264的支持，部分得到布里格姆研究所的支持。
