Progression and Regression of Albuminuria in Type 1 Diabetes

Albuminuria, hypertension, declining kidney function, and an increase in cardiovascular risk are all hallmarks of diabetic kidney disease (DKD). Those clinical features are also related to  premature mortality associated with type 1 diabetes.

In a recent issue of Frontiers in Nephrology [doi.org/10.3389/fneph.2023.1282818], Fanny Jansson Sigfrids, PhD, and colleagues provided an overview of progression and regression of kidney disease in patients with type 1 diabetes.

Early studies of albuminuria related to type 1 diabetes date back to the 1980s. Those studies demonstrated that 35% to 45% pf patients with type 1 diabetes developed proteinuria (equivalent of severe albuminuria), with the diabetes duration-specific incidence rate pattern portraying one or two peaks. In addition, moderate albuminuria was found to progress to overt kidney disease within a short span of time in nearly all patients.

Following the early studies, there have been more recent trials updating incidence rates. Those recent trial results suggest that moderate—rather than severe— albuminuria develops in one-third of patients with type 1 diabetes. Up to 40% of patients progress to more advanced stages over time.

Regression of albuminuria occurs in up to 60% of patients; however, the rate of relapse to a more advanced disease stage is high. There are few and conflicting data on whether albuminuria regression translates into a decline in cardiovascualr disease and premature mortality risk. Another finding is that while the incidence of severe albuminuria has fallen since the 1930s, the decline may have reached a plateau following the 1980s.

The authors added, “This stagnation may be due to the lack of kidney-protective medicines since the early 1980s, as the recent breakthroughs in type 2 diabetes have not been applicable to type 1 diabetes, Therefore, novel treatment strategies are a high priority within this patient population.”

Source: Frontiers in Nephrology