In patients with Type 1 diabetes, the presence and severity of chronic kidney disease predicts all-cause mortality, according to a new report.
Mortality among Type 1 diabetics in Finland is 3 to 4 times that in the general population, the authors explain, but not all patients with Type 1 diabetes share this risk.
Dr. Per-Henrik Groop from Biomedicum Helsinki, using data on 4,201 adults with Type 1 diabetes, determined the incidence and predictors of all-cause mortality.
During a median follow-up of 7 years, mortality in the overall cohort was 3.6 times higher than in the age- and sex-matched general population, the authors report. The excess mortality was more pronounced among women than among men.
The major predictor of all-cause mortality was the presence and severity of kidney disease, according to the researchers.
"Indeed," they report, "excess mortality...was only demonstrated in individuals with chronic kidney disease."
Compared with the general population, mortality was 18.3 times higher in patients with end-stage kidney disease, more than 9 times higher in individuals with macroalbuminuria, and more than twice as high in individuals with microalbuminuria.
Mortality in patients without kidney disease was comparable to that in the general population, no matter the duration of diabetes.
The association between chronic kidney disease and mortality was independent of diabetic control and the use of other therapies, including statins and blockade of the renin-angiotensin system.
"Results from our study clearly demonstrate that chronic kidney disease is the dominant contributor to excess mortality in Type 1 diabetes," the investigators conclude. "Consequently, if you have Type 1 diabetes, prevention of chronic kidney disease is currently the best way to reduce your risk of a premature death."
"For those with established chronic kidney disease, more intensive multifactorial interventions are also valuable in reducing the progression of chronic kidney disease, and, with it, mortality," the authors add.