title: Improved prognosis of diabetic nephropathy in type 1 diabetes.
abstract: The natural history of diabetic nephropathy offered an average survival of only 5-7 years. During the past decades, multiple changes in therapy and lifestyle have occurred. The prognosis of diabetic nephropathy after implementing stricter control of blood pressure (including increased use of long-term renin-angiotensin system inhibition), lipids, and glycemia, along with less smoking and other lifestyle and treatment advancements, is inadequately analyzed. To clarify this, we studied 497 patients with type 1 diabetes and diabetic nephropathy at the Steno Diabetes Center and compared them with previous data, obtained using identical criteria at our hospital. The glomerular filtration rate, measured yearly by 51Cr-EDTA plasma clearance, was a mean of 71 ml/min per 1.73 m2 at baseline. The mean glomerular filtration rate decline was significantly reduced by 19% (95% confidence interval 5-34) from previously 4.0 to 3.3 ml/min per 1.73 m2/year. During a median follow-up of 9.1 years, 29% of participants doubled their plasma creatinine or developed end-stage renal disease. Mortality risk was similar to our prior study (hazard ratio 1.05 (0.76-1.43). However, after age adjustment, as both diabetes and nephropathy onset occurred later in life, mortality was reduced by 30%. Risk factors for decline in glomerular filtration rate, death, and other renal end points were generally in agreement with prior studies. Thus, with current treatment of nephropathy in type 1 diabetes, the prognosis and loss of renal function has improved along with better control of modifiable risk factors.
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Gudbjörg
authors.initials: G
authors.lastname: Andrésdóttir
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Majken L
authors.initials: ML
authors.lastname: Jensen
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Bendix
authors.initials: B
authors.lastname: Carstensen
authors.affiliation: 1] Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark [2] Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark [3] HEALTH, University of Aarhus, Aarhus, Denmark.
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Hovind
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Tine W
authors.initials: TW
authors.lastname: Hansen
authors.affiliation: 1] Steno Diabetes Center, Gentofte, Denmark [2] Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark [3] HEALTH, University of Aarhus, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013997:Time Factors