OBJECTIVE To explore risks and associated mediation effects of developing chronic kidney disease (CKD) and heart failure (HF) in young- and usual-onset type 2 diabetes (T2D) between White Americans (WAs) and African Americans (AAs). RESEARCH DESIGN AND METHODS From U.S. medical records, 1,491,672 WAs and 31,133 AAs were identified and stratified by T2D age of onset (18–39, 40–49, 50–59, 60–70 years). Risks, mediation effects, and time to CKD and HF were evaluated, adjusting for time-varying confounders. RESULTS In the 18–39, 40–49, 50–59, 60–70 age-groups, the hazard ratios (of developing CKD and HF in AAs versus WAs were 1.21 (95% CI 1.17–1.26) and 2.21 (1.98–2.45), 1.25 (1.22–1.28) and 1.86 (1.75–1.97), 1.21 (1.19–1.24) and 1.54 (1.48–1.60), and 1.10 (1.08–1.12) and 1.11 (1.07–1.15), respectively. In AAs and WAs aged 18–39 years, time in years to CKD (8.7 [95% CI 8.2–9.1] and 9.7 [9.2–10.2]) and HF (10.3 [9.3–11.2] and 12.1 [10.6–13.5]) were, on average, 3.6 and 4.0 and 3.1 and 4.1 years longer compared with those diagnosed at age 60–70 years. Compared with females, AA males aged <60 years had an 11–49% higher CKD risk, while WA males aged <40 years had a 23% higher and those aged ≥50 years a 7–14% lower CKD risk, respectively. The mediation effects of CKD on the HF risk difference between ethnicities across age-groups (range 54–91%) were higher compared with those of HF on CKD risk difference between ethnicities across age-groups (13–39%). CONCLUSIONS Developing cardiorenal complications within an average of 10 years of young-onset T2DM and high mediation effects of CKD on HF call for revisiting guidelines on early diagnosis and proactive treatment strategies for effective management of cardiometabolic risk.

中文翻译：

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白人和非裔美国人年轻发病 2 型糖尿病的心肾并发症

目的 探讨美国白人 (WAs) 和非洲裔美国人 (AAs) 在年轻和常发 2 型糖尿病 (T2D) 中发生慢性肾病 (CKD) 和心力衰竭 (HF) 的风险和相关中介效应。研究设 评估了 CKD 和 HF 的风险、中介效应和时间，调整了随时间变化的混杂因素。结果 在 18-39、40-49、50-59、60-70 岁年龄组中，AA 与 WA 发生 CKD 和 HF 的风险比分别为 1.21（95% CI 1.17-1.26）和 2.21（1.98- 2.45)、1.25 (1.22–1.28) 和 1.86 (1.75–1.97)、1.21 (1.19–1.24) 和 1.54 (1.48–1.60)、1.10 (1.08–1.12) 和 1.11 (1.07–1.15)。和 18-39 岁的 WA，到 CKD (8.7 [95% CI 8.2–9.1] 和 9.7 [9.2–10.2]) 和 HF (10.3 [9.3–11.2] 和 12.1 [10.6–13.5]) 平均为 3.6 和 4.0 和 3.1与 60-70 岁诊断的患者相比，延长 4.1 年。与女性相比，年龄 <60 岁的 AA 男性 CKD 风险高 11-49%，而年龄 <40 岁的 WA 男性和 50 岁以上的男性 CKD 风险分别高 23% 和 7-14% . 与 HF 对跨年龄组种族间 CKD 风险差异的中介效应（范围 54-91%）相比，CKD 对跨年龄组种族间 HF 风险差异（范围 54-91%）的中介效应更高（13-39%）。