title: The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes.
abstract: 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.
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland. per-henrik.groop@helsinki.fi
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Groop
authors.forename: Merlin C
authors.initials: MC
authors.lastname: Thomas
authors.forename: John L
authors.initials: JL
authors.lastname: Moran
authors.forename: Johan
authors.initials: J
authors.lastname: Wadèn
authors.forename: Lena M
authors.initials: LM
authors.lastname: Thorn
authors.forename: Ville-Petteri
authors.initials: VP
authors.lastname: Mäkinen
authors.forename: Milla
authors.initials: M
authors.lastname: Rosengård-Bärlund
authors.forename: Markku
authors.initials: M
authors.lastname: Saraheimo
authors.forename: Kustaa
authors.initials: K
authors.lastname: Hietala
authors.forename: Outi
authors.initials: O
authors.lastname: Heikkilä
authors.forename: Carol
authors.initials: C
authors.lastname: Forsblom
mesh_terms: 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
chemical_list: D007328:Insulin