OBJECTIVE The widely adopted Kidney Disease: Improving Global Outcomes (KDIGO) classification system has been underused in assessing the burden and risk of adverse outcomes in type 1 diabetes. This observational study aimed to clarify how each KDIGO category correlates with outcomes, including mortality, in this patient group. RESEARCH DESIGN AND METHODS In 40,199 individuals with type 1 diabetes from the Swedish National Diabetes Register, we examined the 1) prevalence of different KDIGO categories at baseline; 2) incidence of adverse kidney and cardiovascular (CV) outcomes, including mortality, within each category; and 3) association of baseline category with excess risk of five outcomes: 40% decline in estimated glomerular filtration rate (eGFR), kidney failure, major adverse kidney/CV events, and all-cause mortality. Cox regression analyses were conducted using three different reference categories: 1) the conventional low-risk “combined G1A1 + G2A1”; 2) “G1A1” alone to assess whether G2A1 had excess risk; and 3) “G1bA1” alone to evaluate whether eGFR ≥105 mL/min/1.73 m2 had increased risk. RESULTS Among 39,067 included patients, with a mean follow-up of 9.1 years, 18.5% presented with chronic kidney disease (CKD), defined as eGFR <60 mL/min/1.73 m2 and/or albuminuria. A progressive increase in the incidence and adjusted hazard ratio for all studied outcomes was found with advancing eGFR and albuminuria categories, including in G2A1 (non-CKD). A eGFR ≥105 mL/min/1.73 m2 without albuminuria was not associated with increased risk. CONCLUSIONS A progressively increasing burden of all studied adverse outcomes was observed with advancing KDIGO categories. Even individuals with preserved eGFR and normoalbuminuria (G2A1) conventionally perceived as non-CKD, had an excess risk for all outcomes.

中文翻译：

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使用 KDIGO 分类的 1 型糖尿病患者不良后果的负担和超额风险：一项全国队列研究


目的 广泛采用的肾脏疾病：改善全球结果 （KDIGO） 分类系统在评估 1 型糖尿病不良后果的负担和风险方面未得到充分利用。这项观察性研究旨在阐明每个 KDIGO 类别与该患者组的结果（包括死亡率）的相关性。研究设计和方法 在瑞典国家糖尿病登记处的 40,199 名 1 型糖尿病患者中，我们检查了 1） 基线时不同 KDIGO 类别的患病率;2） 每个类别中不良肾脏和心血管 （CV） 结局的发生率，包括死亡率;3） 基线类别与五项结局的超额风险的关联： 估计肾小球滤过率 （eGFR） 下降 40% 、肾衰竭、主要不良肾脏/CV 事件和全因死亡率。使用三个不同的参考类别进行 Cox 回归分析：1） 常规低风险“联合 G1A1 + G2A1”;2） 单独使用“G1A1”来评估 G2A1 是否具有超额风险;3） 单独使用“G1bA1”来评估 eGFR ≥105 mL/min/1.73 m2 是否会增加风险。结果 在 39,067 例纳入的患者中，平均随访 9.1 年，18.5% 的患者患有慢性肾病 （CKD），定义为 eGFR <60 mL/min/1.73 m2 和/或白蛋白尿。发现随着 eGFR 和白蛋白尿类别的进展，包括 G2A1 （非 CKD），所有研究结局的发生率和调整后的风险比进行性增加。无白蛋白尿的 eGFR ≥105 mL/min/1.73 m2 与风险增加无关。结论 随着 KDIGO 类别的推进，观察到所有研究的不良结局的负担逐渐增加。 即使是 eGFR 保留且白蛋白尿正常 （G2A1） 通常被认为是非 CKD 的个体，所有结局的风险也过高。