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Epidemiology of Diabetic Kidney Disease in Adult Patients with Type 1 Diabetes in Italy: the AMD Annals initiative.

Epidemiology of Diabetic Kidney Disease in Adult Patients with Type 1 Diabetes in Italy: the AMD Annals initiative.
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Pacilli A, Viazzi F, Fioretto P, Giorda C, Ceriello A, Genovese S, Russo G, Guida P, Pontremoli R, De Cosmo S, ,


Pacilli A, Viazzi F, Fioretto P, Giorda C, Ceriello A, Genovese S, Russo G, Guida P, Pontremoli R, De Cosmo S, , (click to view)

Pacilli A, Viazzi F, Fioretto P, Giorda C, Ceriello A, Genovese S, Russo G, Guida P, Pontremoli R, De Cosmo S, ,

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Diabetes/metabolism research and reviews 2016 12 09() doi 10.1002/dmrr.2873
Abstract
BACKGROUND
Patients with type 1 diabetes mellitus are at increased risk of death. This risk appears to be modulated by kidney dysfunction. Aim of this study was to evaluate the prevalence of diabetic kidney disease (DKD), its traits and clinical correlates in a large sample of patients with type 1 diabetes.

METHODS
Clinical data of 20,464 patients with type 1 diabetes were extracted from electronic medical records. Estimated glomerular filtration rate (eGFR) and increased urinary albumin excretion were considered.

RESULTS
Mean age of the patients was 46 ± 16 years, 55.0% were males, duration of diabetes 19 ± 13 years. The frequency of DKD, low eGFR and albuminuria was 23.5%, 8.1% and 19.5%, respectively. In the multivariate analysis the presence of DKD was associated with age (OR = 1.14, 95%CI:1.10-1.18), duration of diabetes (OR = 1.05, 95%CI:1.03-1.07) and worse glycemic control (OR = 1.24, 95%CI:1.21-1.28, for every 1% HbA1c increase). DKD was also independently associated with atherogenic lipid profile and increased systolic blood pressure. Glucose control, systolic blood pressure, triglycerides and HDL-cholesterol were associated with both low eGFR and albuminuria. Male gender, retinopathy and smoke were related to albuminuria, being female affects low eGFR, while SUA levels were associated with DKD, low eGFR and albuminuria.

CONCLUSIONS
In our sample of patients with type 1 diabetes, DKD entails an unsafe cardiovascular risk profile. Hyperglycemia, arterial hypertension and atherogenic lipid profile affected both low eGFR and albuminuria. Retinopathy and smoking were related only with albuminuria while being female and serum uric acid were associated only with low eGFR.

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