Age at onset of childhood-onset type 1 diabetes and the development of end-stage renal disease: a nationwide population-based study.
OBJECTIVE
To analyze the impact of age at onset on the development of end-stage renal disease (ESRD) due to diabetic nephropathy in a nationwide population-based cohort with childhood-onset type 1 diabetes.


METHODS
A record linkage between two nationwide registers, the Swedish Childhood Diabetes Registry, including 12,032 cases with childhood-onset diabetes, and the Swedish Registry for Active Treatment of Uraemia was performed. Log-rank test was used to test differences between cumulative risk curves of developing ESRD due to diabetic nephropathy in three different strata of age at onset (0-4, 5-9, and 10-14 years).


RESULTS
At a maximum follow-up of 27 years, 33 patients had developed ESRD due to diabetic nephropathy and all had a diabetes duration >15 years. In total, 4,414 patients had diabetes duration >15 years, and thus the risk in this cohort to develop ESRD was 33 of 4,414 (0.7%). A significant difference in risk of developing ESRD was found between the youngest (0-4 years) and the two older (5-9 and 10-14 years) age-at-onset strata (P = 0.03 and P = 0.001, respectively). A significant difference in the risk of developing ESRD was also found between children with prepubertal (0-4 and 5-9 years, n = 2,424) and pubertal (10-14 years, n = 2000) onset of diabetes (P = 0.002). No patient with onset of diabetes before 5 years of age had developed ESRD.


CONCLUSIONS
With a median duration of 21 years in this population-based Swedish cohort with childhood-onset diabetes, <1% of the patients had developed ESRD due to diabetic nephropathy, and a prepubertal onset of diabetes seems to prolong the time to development of ESRD.
Svensson
Maria
M
Department of Medicine, Umeå University Hospital, SE-901 85 UMEA, Sweden. maria.svensson@medicin.umu.se
Nyström
Lennarth
L
Schön
Staffan
S
Dahlquist
Gisela
G
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D011627:Puberty; D012042:Registries; D013548:Sweden / Q000453:epidemiology