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Association between glycosylated hemoglobin level and 16-year incidence of chronic kidney disease in type 1 diabetes.

CONTEXT
The incidence of recently defined outcome of chronic kidney disease (CKD) has not been widely reported in type 1 diabetes.


OBJECTIVE
To examine the prospective association between baseline glycosylated hemoglobin levels and the 16-year incidence of CKD and end-stage renal disease (ESRD) in type 1 diabetes.


DESIGN
Prospective cohort study of type 1 diabetes individuals.


SETTING
Community based in southwestern Wisconsin.


PARTICIPANTS
547 younger-onset type 1 diabetes individuals who were free of CKD at baseline (1984-86).


MAIN OUTCOME MEASURES
Development of CKD (defined as estimated glomerular filtration rate<60 ml/min/1.73 m(2) or ESRD [history of dialysis or renal transplantation]) over 16-year follow-up period, among individuals free of CKD at baseline. Alternate outcome was 16-year incident ESRD.


RESULTS
After 16 years of follow-up, there were 158 cases of CKD and 37 cases of ESRD in our cohort. The 16-year cumulative incidence of CKD was 31.7 percent. Elevated glycosylated hemoglobin levels were associated with incident CKD and ESRD in separate models. Multivariable odds ratio (OR) [95% confidence intervals (CI)] comparing the highest quartile of glycosylated hemoglobin (11-15.3%) to the lowest quartile (6-8.6%) was 6.44 (3.61-11.51), p-trend<0.0001 for incident CKD and 21.87 (2.84-168.39), p-trend<0.0001 for ESRD.


CONCLUSIONS
Higher baseline glycosylated hemoglobin levels are independently associated with incident CKD and ESRD, among individuals with type 1 diabetes.