The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes.
OBJECTIVE
This study aimed to identify clinical features associated with premature mortality in a large contemporary cohort of adults with type 1 diabetes.


METHODS
The Finnish Diabetic Nephropathy (FinnDiane) study is a national multicenter prospective follow-up study of 4,201 adults with type 1 diabetes from 21 university and central hospitals, 33 district hospitals, and 26 primary health care centers across Finland.


RESULTS
During a median 7 years of follow-up, there were 291 deaths (7%), 3.6-fold (95% CI 3.2-4.0) more than that observed in the age- and sex-matched general population. Excess mortality was only observed in individuals with chronic kidney disease. Individuals with normoalbuminuria showed no excess mortality beyond the general population (standardized mortality ratio [SMR] 0.8, 95% CI 0.5-1.1), independent of the duration of diabetes. The presence of microalbuminuria, macroalbuminuria, and end-stage kidney disease was associated with 2.8, 9.2, and 18.3 times higher SMR, respectively. The increase in mortality across each stage of albuminuria was equivalent to the risk conferred by preexisting macrovascular disease. In addition, the glomerular filtration rate was independently associated with mortality, such that individuals with impaired kidney function, as well as those demonstrating hyperfiltration, had an increased risk of death.


CONCLUSIONS
An independent graded association was observed between the presence and severity of kidney disease and mortality in a large contemporary cohort of individuals with type 1 diabetes. These findings highlight the clinical and public health importance of chronic kidney disease and its prevention in the management of type 1 diabetes.
Groop
Per-Henrik
PH
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland. per-henrik.groop@helsinki.fi
Thomas
Merlin C
MC
Moran
John L
JL
Wadèn
Johan
J
Thorn
Lena M
LM
Mäkinen
Ville-Petteri
VP
Rosengård-Bärlund
Milla
M
Saraheimo
Markku
M
Hietala
Kustaa
K
Heikkilä
Outi
O
Forsblom
Carol
C
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002423:Cause of Death; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000401:mortality; D003928:Diabetic Nephropathies / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
D007328:Insulin