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Kidney failure risk in type 1 vs. type 2 childhood-onset diabetes mellitus

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Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Diabetic kidney disease (DKD) is becoming increasingly common among children. We aimed to estimate the risk of end-stage renal disease (ESKD) and mortality among adolescents with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and normal renal function compared with non-diabetics. We hypothesized that childhood onset T1DM vs. T2DM would be associated with a different risk profile for developing ESKD and its complications.

Methods

A nationwide, population-based, retrospective cohort study, including 1,500,522 adolescents examined for military service between 1967 and 1997, which were classified according to the presence and type of diabetes. Data were linked to the Israeli ESKD registry. Cox proportional-hazards models were used to estimate the hazard ratio (HR) for ESKD.

Results

At study enrolment, 1183 adolescents had T1DM and 196 had T2DM. ESKD developed in 2386 non-diabetic individuals (0.2%) compared with 72 individuals (6.1%) with T1DM and 8 individuals (4.1%) with T2DM. Participants with T1DM were younger at ESKD onset than participants with T2DM (median age, 36.0 vs. 40.5 years, P < 0.05). In a multivariate model adjusted for age, sex, paternal origin, enrollment year, BMI, and blood pressure, T1DM and T2DM were associated with HR of 36.4 (95% CI 28.3–46.9) and 19.3 (95% CI 9.6–38.8) for ESKD, respectively. Stratification according to sex, ethnicity, immigration, and socioeconomic status did not materially change the HR. During the follow-up period, mortality rates were higher in T2DM as compared with T1DM and controls (8.7 %, 2.2%, and 2.7% respectively).

Conclusions

T1DM and T2DM in adolescents with normal renal function confer a significantly increased risk for ESKD. T1DM is associated with younger age at ESKD onset while T2DM is associated with higher mortality rate.

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Author information

Author notes

  1. Ronit Calderon-Margalit and Asaf Vivante contributed equally to this work.

Authors and Affiliations

  1. Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel

    Oren Pleniceanu, Gilad Twig, Dorit Tzur & Tomer Erlich

  2. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Oren Pleniceanu, Gilad Twig, Noah Gruber, Michal Stern-Zimmer, Arnon Afek, Tomer Erlich & Asaf Vivante

  3. Department of Pediatrics B and Pediatric Nephrology unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, 5265601, Ramat Gan, Israel

    Oren Pleniceanu, Michal Stern-Zimmer & Asaf Vivante

  4. Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Gilad Twig & Asaf Vivante

  5. Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel

    Noah Gruber

  6. Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Arnon Afek

  7. Urology Department, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Tomer Erlich

  8. Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel

    Lital Keinan-Boker

  9. School of Public Health, University of Haifa, Haifa, Israel

    Lital Keinan-Boker

  10. Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel

    Karl Skorecki

  11. Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel

    Ronit Calderon-Margalit

Authors
  1. Oren Pleniceanu
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  2. Gilad Twig
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  3. Dorit Tzur
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  6. Arnon Afek
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  8. Lital Keinan-Boker
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  9. Karl Skorecki
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  10. Ronit Calderon-Margalit
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  11. Asaf Vivante
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Corresponding authors

Correspondence to Ronit Calderon-Margalit or Asaf Vivante.

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The institutional review board of the Israel Defense Forces approved the study and waived the requirement for informed consent on the basis of preserving participants’ anonymity.

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The authors declare that they have no conflict of interest.

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Pleniceanu, O., Twig, G., Tzur, D. et al. Kidney failure risk in type 1 vs. type 2 childhood-onset diabetes mellitus. Pediatr Nephrol 36, 333–340 (2021). https://doi.org/10.1007/s00467-020-04631-2

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  • DOI: https://doi.org/10.1007/s00467-020-04631-2

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