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Kidney Week

Abstract: SA-PO552

Visit-to-Visit Variability of Albuminuria and eGFR as Risk Markers for Renal Complications, Cardiovascular Events, and Mortality in Type 1 Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Rotbain Curovic, Viktor, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Theilade, Simone, Steno Diabetes Center, Hellerup, Denmark
  • Winther, Signe Abitz, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Tofte, Nete, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Jorsal, Anders, Aarhus University Hospital, Aarhus, Denmark
  • Parving, Hans-Henrik, Rigshospitalet, Copenhagen, Denmark
  • Persson, Frederik, Steno Diabetes Center, Hellerup, Denmark
  • Hansen, Tine, Steno Diabetes Center, Hellerup, Denmark
  • Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark
Background

Clinicians strive towards determining stable and reliable measures for monitoring risk of diabetic complications. The impact of visit-to-visit variability (VVV) of albuminuria (ALB) and eGFR needs further clarification. We investigated VVV in ALB and eGFR as risk markers of renal complications, cardiovascular events (CVE), and mortality in subjects with type 1 diabetes (T1D).

Methods

1077 individuals with T1D a range of albuminuria were included. VVV was defined as the standard deviation (SD) of the residuals in individual linear regression models, calculated using all measures of ALB or eGFR from 1998-2016. Data on end-stage renal disease (ESRD), CVE and mortality were gathered through national registers. eGFR and ALB was traced through laboratory records from ambulatory care. Endpoints were ESRD (CKD stage 5, dialysis or transplantation), eGFR-decline ≥30%, CVE (cardiac death, myocardial infarction, stroke and arterial interventions) and mortality. Hazard ratios (HR) were calculated using Cox models and are presented per doubling of VVV. Adjustment included sex, age, total cholesterol, HbA1c, systolic blood pressure, body mass index, smoking, 24h ALB, eGFR, and the intercept and slope of the respective linear models.

Results

Median follow-up ranged from 6.1-13.4 years for ALB and 6.8-16.2 years for eGFR, depending on endpoint. Subjects had a mean (SD) age and diabetes duration of 47 (13) and 27 (13) years, respectively, at baseline. Depending on availability of data, between 848-1077 subjects were included in the respective models. Adjusted HR (95% CI, p) for ALB VVV were 1.68 (1.38-2.05, p<0.001), 1.34 (1.25-1.44, p<0.001), 1.12 (1.04-1.20, p=0.002) and 1.10 (1.01-1.19, p=0.029) for development of ESRD, eGFR decline ≥30%, CVE and mortality, respectively. Adjusted HR (95% CI, p) for eGFR VVV were 1.78 (1.29-2.45, p<0.001), 2.02 (1.68-2.43, p<0.001), 0.96 (0.85-1.08, p=0.091) and 0.93 (0.79-1.11, p=0.424) respectively.

Conclusion

We demonstrate an independent association between long term VVV in ALB and development of renal complications, CVE and mortality in T1D, and in eGFR VVV for development of renal complications. Studies addressing stabilization of VVV and reduction of endpoints, are warranted.