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Abstract: PO2307

ESRD Risk in Type 1 vs. Type 2 Childhood-Onset Diabetes Mellitus

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Pleniceanu, Oren, Pediatric Stem Cell Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
  • Twig, Gilad, Israel Defense Forces, Tel Aviv, Tel Aviv, Israel
  • Erlich, Tomer, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
  • Keinan Boker, Lital, University of Haifa School of Public Health, Haifa, Haifa, Israel
  • Skorecki, Karl, Rambam Health Care Campus, Haifa, Haifa, Israel
  • Calderon-margalit, Ronit, Hebrew University of Jerusalem Braun School of Public Health and Community Medicine, Jerusalem, Jerusalem, Israel
  • Vivante, Asaf, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
Background

Diabetic kidney disease (DKD) is becoming increasingly common among children. We aimed to estimate the risk of end-stage renal disease (ESRD) and mortality among adolescents with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and normal renal function compared to non-diabetics. We hypothesized that childhood onset T1DM vs T2DM would be associated with a different risk profile for developing ESRD and its complications.

Methods

A nationwide, population-based, retrospective cohort study, including 1,500,522 adolescents examined for military service between 1967-1997, which were classified according to the presence and type of diabetes. Data were linked to the Israeli ESRD registry. Cox proportional-hazards models were used to estimate the hazard ratio (HR) for ESRD.

Results

At study enrolment, 1,183 adolescents had T1DM and 196 had T2DM. ESRD developed in 2,386 non-diabetic individuals (0.2%) compared to 72 individuals (6.1%) with T1DM, and 8 individuals (4.1%) with T2DM. Participants with T1DM were younger at ESRD onset than participants with T2DM (median age: 36.0 vs. 40.5 years, P<0.05). In a multivariate model adjusted for age, sex, paternal origin, enrollment year, BMI, and blood pressure, T1DM and T2DM were associated with HR of 36.4 (95% CI, 28.3-46.9) and 19.3 (95%CI, 9.6-38.8) for ESRD, respectively. Stratification according to sex, ethnicity, immigration and socioeconomic status did not materially change the HR. During the follow-up period, mortality rates were higher in T2DM as compared to T1DM and controls (8.7 %, 2.2% and 2.7% respectively).

Conclusion

T1DM and T2DM in adolescents with normal renal function confer a significantly increased risk for ESRD. T1DM is associated with younger age at ESRD onset while T2DM is associated with higher mortality rate.

Cumulative ESRD incidence