AIMS/HYPOTHESIS The aim of this study was to provide data from a contemporary population-representative cohort on rates and predictors of renal decline in type 1 diabetes. METHODS We used data from a cohort of 5777 people with type 1 diabetes aged 16 and older, diagnosed before the age of 50, and representative of the adult population with type 1 diabetes in Scotland (Scottish Diabetes Research Network Type 1 Bioresource; SDRNT1BIO). We measured serum creatinine and urinary albumin/creatinine ratio (ACR) at recruitment and linked the data to the national electronic healthcare records. RESULTS Median age was 44.1 years and diabetes duration 20.9 years. The prevalence of CKD stages G1, G2, G3 and G4 and end-stage renal disease (ESRD) was 64.0%, 29.3%, 5.4%, 0.6%, 0.7%, respectively. Micro/macroalbuminuria prevalence was 8.6% and 3.0%, respectively. The incidence rate of ESRD was 2.5 (95% CI 1.9, 3.2) per 1000 person-years. The majority (59%) of those with chronic kidney disease stages G3-G5 did not have albuminuria on the day of recruitment or previously. Over 11.6 years of observation, the median annual decline in eGFR was modest at -1.3 ml min-1 [1.73 m]-2 year-1 (interquartile range [IQR]: -2.2, -0.4). However, 14% experienced a more significant loss of at least 3 ml min-1 [1.73 m]-2. These decliners had more cardiovascular disease (OR 1.9, p = 5 × 10-5) and retinopathy (OR 1.3 p = 0.02). Adding HbA1c, prior cardiovascular disease, recent mean eGFR and prior trajectory of eGFR to a model with age, sex, diabetes duration, current eGFR and ACR maximised the prediction of final eGFR (r2 increment from 0.698 to 0.745, p < 10-16). Attempting to model nonlinearity in eGFR decline or to detect latent classes of decliners did not improve prediction. CONCLUSIONS These data show much lower levels of kidney disease than historical estimates. However, early identification of those destined to experience significant decline in eGFR remains challenging.

中文翻译：

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预测大型当代 1 型糖尿病队列的肾脏疾病进展。

目的/假设 本研究的目的是提供来自当代人群代表性队列的数据，以了解 1 型糖尿病患者肾衰竭的发生率和预测因素。方法 我们使用了来自 5777 名年龄在 16 岁及以上、50 岁之前被诊断出患有 1 型糖尿病且代表苏格兰成人 1 型糖尿病人群的队列数据（苏格兰糖尿病研究网络 1 型生物资源；SDRNT1BIO）。我们在招募时测量了血清肌酐和尿白蛋白/肌酐比值 (ACR)，并将数据与国家电子医疗记录相关联。结果 中位年龄为 44.1 岁，糖尿病病程为 20.9 年。CKD G1、G2、G3、G4 期和终末期肾病（ESRD）的患病率分别为 64.0%、29.3%、5.4%、0.6%、0.7%。微量/大量白蛋白尿的患病率分别为 8.6% 和 3.0%。ESRD 的发病率为每 1000 人年 2.5（95% CI 1.9，3.2）。大多数 (59%) 慢性肾病 G3-G5 期患者在招募当天或之前没有蛋白尿。在超过 11.6 年的观察中，eGFR 的年平均下降幅度为 -1.3 ml min-1 [1.73 m]-2 year-1（四分位距 [IQR]：-2.2，-0.4）。然而，14% 的人经历了至少 3 ml min-1 [1.73 m]-2 的更显着损失。这些下降者有更多的心血管疾病 (OR 1.9, p = 5 × 10-5) 和视网膜病变 (OR 1.3 p = 0.02)。将 HbA1c、既往心血管疾病、近期平均 eGFR 和既往 eGFR 轨迹添加到具有年龄、性别、糖尿病持续时间、当前 eGFR 和 ACR 的模型中，可最大限度地预测最终 eGFR（r2 从 0.698 增加到 0.745，p < 10-16） . 尝试对 eGFR 下降的非线性进行建模或检测潜在的下降类别并没有改善预测。结论 这些数据显示肾脏疾病的发生率远低于历史估计值。然而，早期识别那些注定要经历 eGFR 显着下降的人仍然具有挑战性。