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Pediatric diabetes and incidence of future early-onset kidney disease

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Dr Sanjay Kalra, DM (AIIMS); President-elect, SAFES, Bharti Hospital, Karnal, India; Dr Mudita Dhingra, Consultant Diabetologist and Pediatric Endocrinologist, Shree Guru Kripa Endocrine Clinic, Kurukshetra    10 January 2023

Children with type 2 diabetes are at greater risk of early onset of kidney disease subsequently, accordingly to a study published in the journal BMC Medicine.1

 

A total of 9356 Danish citizens with diabetes diagnosed during their childhood were included in this study to investigate the association of pediatric diabetes with overall and type-specific early-onset kidney diseases later in life. Of the study group comprising individuals born between 1977 and 2016 in Denmark, 8470 were type 1 diabetic, while 886 had type 2 diabetes. A group of 93,560 non-diabetic persons, matched on sex and year of birth, served as the control group.

 

The overall risk of early-onset kidney disease, the primary outcome of the study, was increased 154% among children with diabetes during follow-up of 13 years (median) than in children who did not have diabetes, with an adjusted hazard ratio of 2.54. The aHR for children with type 1 diabetes was 2.48 and 2.75 for children with type 2 diabetes.

 

The study, which also examined the association of childhood diabetes with type-specific kidney diseases, also found a higher risk for various kidney diseases among children with diabetes such as renal tubulo-interstitial diseases (aHR 2.74), glomerular diseases (aHR 3.56), kidney stone disease (aHR 1.39) and kidney failure (aHR 9.13). The association was more robust for children with type 2 diabetes compared to those with type 1 diabetes. The risk of glomerular disease was increased nearly 6-folds among those with type 2 diabetes with aHR 5.84 vs 3.14 among children with type 1 diabetes. Children with type 2 diabetes were nearly 15 times more likely to develop renal failure than those with type 1 diabetes (aHR 14.77 vs 8.24, respectively).

 

The rate of occurrence of kidney disease was higher among older children (diagnosed at 6–12 years or 13–17 years vs 0-5 years) and children with long-standing diabetes (10–20 years and ≥ 21 years vs 0–10 years). Children who had had at least one diabetes-related complication were also more likely to develop kidney disease later on than those without any diabetic complication.

 

These observations point out the higher incidence of ensuing early-onset kidney diseases among children with diabetes. The probability was higher among children who were diagnosed at the age of 6-17 years or those who had long-standing diabetes. While prevention of diabetes is the key mantra, early diagnosis and treatment of both type 1 and type 2 diabetes in childhood may mitigate the risk of future kidney disease.

 

Reference

 

  1. Sun J, et al. Childhood diabetes mellitus and early-onset kidney diseases later in life: a nationwide population-based matched cohort study. BMC Med. 2022 Nov 8;20(1):428. doi: 10.1186/s12916-022-02634-4.

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