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Abstract: TH-PO231

Youth-Onset Type 2 Diabetes Associated With Higher Risk of Kidney Failure

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Looker, Helen C., National Institute of Diabetes and Digestive and Kidney Diseases; CKDS, Phoenix, Arizona, United States
  • Saulnier, Pierre Jean, Universite de Poitiers, Poitiers, Nouvelle-Aquitaine, France
  • Vigers, Tim, University of Colorado Health, Aurora, Colorado, United States
  • Pyle, Laura, University of Colorado Health, Aurora, Colorado, United States
  • Bjornstad, Petter, University of Colorado Health, Aurora, Colorado, United States
  • Nelson, Robert G., National Institute of Diabetes and Digestive and Kidney Diseases; CKDS, Phoenix, Arizona, United States
Background

The prevalence of youth-onset type 2 diabetes (T2D) is increasing and may have a more severe phenotype than adult-onset T2D. Youth-onset T2D in American Indians is associated with more severe structural lesions than adult-onset T2D of similar duration. We examine risk of kidney failure in youth-onset (<25 years) and adult-onset (≥25 years) T2D in the same population.

Methods

American Indians with T2D and repeated measures of GFR were followed from first GFR measurement in the study after the age of 25 years for onset of kidney failure. Risk of kidney failure was examined by Cox proportional-hazards in participants with youth-onset T2D compared to adult-onset T2D.

Results

85 participants had youth-onset T2D and 239 had adult-onset T2D. Youth-onset participants were younger, more often female, and had longer diabetes duration, poorer glycemic control, and higher GFR at baseline than adult-onset participants (Table). Over a median follow-up of 19.9 (IQR 9.3-28.3) years there were 95 cases of kidney failure (34 in youth-onset, 61 in adult-onset). The Hazard Rate Ratio (HRR) for incident kidney failure in youth-onset T2D was 2.08 (95% CI 1.23-3.53) times as high as in adult-onset T2D after adjustment for sex and baseline age. The association was attenuated by inclusion of HbA1c in the model (HRR 1.43, 95% CI 0.80-2.56). When younger age at onset was considered as a continuous variable, the HRR for kidney failure per year was 1.07 (95% CI 1.04-1.09) after adjustment for sex, baseline GFR, blood pressure, and HbA1c, reflecting a 7% higher risk of kidney failure for each earlier year of age at diabetes diagnosis.

Conclusion

Youth-onset T2D is associated with more severe structural lesions and a greater risk of kidney failure despite higher GFR at baseline. Poorer glycemic control in the youth-onset group may contribute to their more rapid progression of kidney disease.

 All (n=325) Older onset (n=239)Youth onset (n=86)p-value
Age (years)42.0 ± 10.245.5 ± 8.932.4 ± 6.9<0.0001
Diabetes duration (years)10.4 ± 6.89.8 ± 6.612.2 ± 6.80.004
Male sex (%)106 (32.6%)90 (37.7%)16 (18.6%)0.001
Body mass index (kg/m2)35.5 ± 8.135.6 ± 7.735.1 ± 9.20.64
HbA1c (%)9.2 ± 2.3*8.9 ± 2.3**10.0 ± 2.2<0.0001
Mean arterial pressure (mmHg)92.1 ± 10.892.8 ± 10.990.2 ± 10.30.06
Glomerular filtration rate (ml/min)152 ± 50144 ± 45177 ± 53<0.0001
Albumin:creatinine ratio (mg/g)36 (12-130)*30 (11-119)**46 (18-147)0.11

*n=322; **n=236

Funding

  • NIDDK Support