OBJECTIVE A common belief is that only a minority of patients with type 1 diabetes (T1D) develop advanced kidney disease and that incidence is higher among men and lower in those diagnosed at a younger age. However, because few patients with T1D survived to older ages until recently, long-term risks have been unclear.

RESEARCH DESIGN AND METHODS We examined the 50-year cumulative kidney complication risk in a childhood-onset T1D cohort diagnosed during 1950–80 (n = 932; mean baseline age 29 years, duration 19 years). Participants comprised 144 who died prior to baseline, 130 followed with periodic surveys, and 658 followed with biennial surveys and a maximum of nine examinations for 25 years. Micro- and macroalbuminuria were defined as an albumin excretion rate of 20–199 and ≥200 μg/min, respectively, and end-stage renal disease (ESRD) was defined as dialysis or kidney transplantation. Cumulative incidence was estimated at 10-year intervals between 20 and 50 years^, duration and compared by calendar year of diabetes onset.

RESULTS By 50 years^, T1D duration, ESRD affected 60% of the cohort; macroalbuminuria, 72%; and microalbuminuria, 88%. Little evidence existed for declines in cumulative incidence in recent cohorts, except for ESRD (microalbuminuria 3% increase, macroalbuminuria no change; ESRD 45% decrease by 40 years of T1D duration). Onset before age 6 years was associated with the lowest risk; incidence generally did not differ by sex.

CONCLUSIONS Some degree of kidney disease in T1D is virtually universal at long durations and not declining, which has major implications for formulating health care and research strategies. ESRD has declined, but continues to affect >25% of the population by 40 years^, duration.

目的普遍认为，只有少数1型糖尿病（T1D）患者会发展为晚期肾脏疾病，男性的发病率较高，而年轻时的发病率较低。但是，由于直到最近，很少有T1D患者能够存活到更高的年龄，因此长期风险尚不清楚。

研究设计和方法我们研究了1950-80年间诊断为儿童期T1D队列的50年累积肾脏并发症风险（n = 932；平均基线年龄29岁，病程19年）。参加者包括144名在基线之前死亡的患者，130名进行定期调查的患者，658名进行了两年一次的调查和25年内最多9次检查的患者。微量白蛋白尿和大白蛋白尿定义为白蛋白排泄率分别为20-199和≥200μg/ min，终末期肾脏疾病（ESRD）定义为透析或肾脏移植。累积发生率以20年至50年之间的10年间隔^（持续时间）估算^，并按糖尿病发作的历年进行比较。

结果到50年^， T1D持续时间，ESRD影响了60％的队列；巨蛋白尿，72％; 和微量白蛋白尿，占88％。除ESRD外，几乎没有证据表明最近人群的累积发生率下降（微量白蛋白尿增加3％，巨蛋白尿没有变化；在T1D持续时间40年后，ESRD减少45％）。6岁之前发病与最低风险相关。发病率一般不因性别而异。

结论T1D的某种程度的肾脏疾病从长远来看实际上是普遍的，并且没有下降，这对制定医疗保健和研究策略具有重要意义。ESRD有所下降，但继续了40年的影响>总人口的25％ ^，持续时间。