Prof. Josephine Forbes1, Ms Qianlin Zhang1, Ms Tracey Baskerville1, Dr Uyen Pham1, Dr Mitchell Sullivan1, Dr Amelia Fotheringham1, Prof David Johnson4, Prof Andrew Cotterill5, A/Prof Trisha O’Moore-Sullivan3, Dr Liza Phillips3, A/Prof Helen Barrett2
1Mater Research Institute – The University Of Queensland, Brisbane, Australia, 2Faculty of Medicine, The University of Queensland, Brisbane, Australia, 3Mater Young Adult Health Centre, Mater Health, Brisbane, Australia, 4The Metro South Integrated Nephrology and Transplant Service (MINTS), Princess Alexandra Hospital, Wooloongabba, Australia, 5Queensland Children’s Hosptial, CHildren’s Health Qld, Brisbane, Australia
Aim/Background: With increasing rates of diabetes in youth, understanding factors which could predict risk for kidney (DKD) and cardiovascular disease in early life is key. A rapid rate of decline in kidney function using estimated GFR (eGFR), has stratified those adults with Type 1 diabetes (T1DM) at increased risk but is less well characterised in younger cohorts.
Methods: Youth with T1DM who attended the Mater Young Adult Health Centre Diabetes clinic 2016-2020 were included. Of 870 unique individuals, data collation and sub-analysis for N=198 individuals has been completed. In this initial pilot, eGFR trajectory between 2014-2019 (eGFRCKD-EPI;KDIGO 2020) and DKD risk factors uACR; diabetes duration, glucose control (HbA1C), adiposity (BMI), lipids and blood pressure (SBP) were examined.
Results: There was early rapid decline of > -5mL/min/1.73m2/year from 2014-2019 in 11% of individuals (Rapid, 145±13 to 112±15, P<0.001; Slow, 134±13 to 129±13 mL/min/1.73m2, P=0.02 vs Rapid). Prevalence of micro/macroalbuminuria increased from 10.8% in 2014 to 28.6% by 2019. However >50% of those with rapid eGFR decline were normoalbuminuric and younger (2014, 15[9] vs 22[2]yrs; P=0.001), but had a similar diabetes duration (2014, 7±6 vs 8±4yrs; P=0.25) to those with more stable eGFR. No differences were seen in HbA1C, BMI, total cholesterol, SBP and sex between eGFR trajectory groups in 2014 or 2019.
Conclusions: Completion of the full cohort will provide clarity around the proportions of individuals with rapid eGFR decline over time. Given that all eGFR values were still above 100mL/min/1.73m2 by 2019 and did not align with albuminuria, further follow up is warranted to understand the clinical significance of these early changes. Analysis of eGFR slope using other eGFR estimators, such as the Modified Schwartz, for concordance would also be warranted in the future.
Biography:
Professor Josephine Forbes is a global leader driving innovative therapies for diabetic kidney disease. She fosters her pioneering bench research all the way to clinical studies. Her accolades include the Commonwealth Health Minister’s Award for Outstanding contribution to Medical Research. She already has over 150 publications, >12000 citations, >$10 m in research funding as lead, patents and commercial partners. She is consistently invited to lecture nationally and internationally and as a member of global/national scientific committees. Her peak body leadership roles in the Australian Diabetes Society and as their Research Chair ensure strong advocacy for health research/ers and consumers.