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Glomerular Filtration Rate Abnormalities in Children With Type 1 Diabetes

Published:January 28, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.01.007

      Abstract

      Objectives

      Type 1 diabetes (T1D) increases the risk of chronic kidney disease (CKD) development. The primary objective of this study was to assess the prevalence of abnormalities in estimated glomerular filtration rate (eGFR) in children with T1D. As a secondary objective, we sought to explore the relationship between clinical characteristics and abnormalities in eGFR.

      Methods

      This cross-sectional study involved children ≤18 years of age with T1D followed in the diabetes clinic at a pediatric tertiary care centre. Data were collected from health records between 2016 and 2020. Using the Bedside Schwartz, Chronic Kidney Disease in Children Under 25 (CKiD U25) and European Kidney Function Consortium (EKFC) equations, eGFR was categorized as CKD (<60 mL/min/1.73 m2), mildly decreased (60 to <90 mL/min/1.73 m2), normal (90 to <158 mL/min/1.73 m2) and hyperfiltration (≥158 mL/min/1.73 m2). Linear regression analysis was used to describe the relationship between eGFR and clinical characteristics.

      Results

      Of the 420 participants, 225 were male (54%); the median age at diagnosis and duration of T1D were 6.1 and 4.8 years, respectively. The proportion of participants with mildly decreased eGFR was similar regardless of eGFR equation, with 11% to 14% of participants with an eGFR <90 mL/min/1.73 m2. When analyzed as a function of duration of T1D, eGFR was 1.4 mL/min/1.73 m2 lower per year duration of T1D.

      Conclusions

      A notable proportion of children with T1D demonstrates eGFR abnormalities early in their T1D course. This finding along with evidence of lower eGFR in adolescence is concerning for long-term risk of CKD and warrants systematic serum creatinine monitoring at diagnosis and regular intervals thereafter in children with T1D.

      Résumé

      Objectifs

      Le diabète de type 1 (DT1) fait augmenter le risque d’apparition de la maladie rénale chronique (MRC). Le principal objectif de la présente étude était d’évaluer la prévalence des anomalies du débit de filtration glomérulaire estimé (DFGe) chez les enfants atteints du DT1. À titre d’objectif secondaire, nous avons cherché à explorer la relation entre les caractéristiques cliniques et les anomalies du DFGe.

      Méthodes

      Cette étude transversale portait sur les enfants atteints du DT1 de ≤ 18 ans qui étaient suivis dans une clinique du diabète d’un centre de soins tertiaires pour enfants. Les données provenaient des dossiers médicaux de 2016 à 2020. À l’aide des équations de la Chronic Kidney Disease in Children Under 25 (CKiD U25) et du European Kidney Function Consortium (EKFC) selon la formule de Schwartz au chevet, le DFGe était dans la catégorie de la MRC (< 60 mL/min/1,73 m2), de légère diminution (de 60 à < 90 mL/min/1,73 m2) et d’hyperfiltration. Nous avons utilisé l’analyse de régression linéaire pour décrire la relation entre le DFGe et les caractéristiques cliniques.

      Résultats

      Parmi les 420 participants, 225 étaient des garcons (54 %); l’âge médian au diagnostic et la durée du DT1 étaient respectivement de 6,1 ans et de 4,8 ans. La proportion de participants qui avaient une légère diminution du DFGe était similaire en dépit de l’équation du DFGe, soit de 11 % à 14 % des participants qui avaient un DFGe < 90 mL/min/1,73 m2. Lorsque le DFGe était analysé en fonction de la durée du DT1, il était inférieur de 1,4 ml/min/1,73 m2 par année de DT1.

      Conclusions

      Une proportion notable d’enfants atteints du DT1 démontrent précocement des anomalies du DFGe au cours de l’évolution de leur DT1. Ces conclusions, de même que les données sur la diminution du DFGe à l’adolescence rendent préoccupant le risque à long terme de la MRC, et justifient la surveillance systématique de la créatinine sérique au diagnostic et à des intervalles réguliers par la suite chez les enfants atteints du DT1.

      Keywords

      Mots clés

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