Diabetic kidney disease in type 1 diabetes: challenges and differences from type 2 diabetes

Diabetic kidney disease (DKD) is a major cause of premature mortality among persons living with type 1 diabetes (T1D). The presence of microalbuminuria, macroalbuminuria, or end-stage kidney disease (ESKD) in T1D individuals is associated with a respective 2.8, 9.2, and 18.3-fold increase in mortality risk, when compared to the general population [ 1 Groop P.H. Thomas M.C. Moran J.L. Wadèn J. Thorn L.M. Mäkinen V.P. et al. The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Diabetes. 2009; 58: 1651-1658 Crossref PubMed Scopus (500) Google Scholar ]. Lifetime risk for developing DKD in T1D ranges between 25 % and 70 % [ 2 Gillard P. Schnell O. Groop P.H. The nephrological perspective on SGLT-2 inhibitors in type 1 diabetes. Diabetes Res Clin Pract. 2020; 170108462 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar ]. It has been estimated that one quarter of individuals with T1D and microalbuminuria will ultimately progress to ESKD [ 3 Bjornstad P. Cherney D. Maahs D.M. Early diabetic nephropathy in type 1 diabetes: new insights. Curr Opin Endocrinol Diabetes Obes. 2014; 21: 279-286 Crossref PubMed Scopus (97) Google Scholar ]. The reported incidence of ESKD depends on T1D duration, reaching 9.3–11.3 % 25 years after diabetes diagnosis among individuals with T1D in the United States [ 4 Nishimura R. Dorman J.S. Bosnyak Z. Tajima N. Becker D.J. Orchard T.J. et al. Incidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: a report from the Allegheny County registry. Am J Kidney Dis. 2003; 42: 117-124 Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar ].