MON-640 - Clinical Predictors of Kidney Dysfunction in Type 1 Diabetes Mellitus: A Stratified Analysis by Gender and Ketoacidosis

Background: Type 1 diabetes (T1DM) is a well-established risk factor for chronic kidney disease (CKD), typically manifesting as diabetic kidney disease (DKD). CKD severity is classified by the KDIGO guidelines, which combine glomerular filtration rate (GFR) and albuminuria categories.

Objective: To assess CKD occurrence and staging in individuals with T1DM, correlating kidney function with clinical factors, and evaluating the influence of gender, insulin regimen, and diabetic ketoacidosis (DKA) at disease onset on renal outcomes.

Methods: An observational, retrospective study analyzing data from 530 patients with T1DM followed at a single university hospital between January 2014 and June 2025. CKD staging was determined based on GFR and albuminuria, and its association with clinical parameters was evaluated.

Results: The cohort included 298 women (56.2%) and 232 men (43.8%), with a median age of 28 years (interquartile range [IQR]: 22–36). Reduced GFR (stage G3a or worse) was identified in 57 patients (10.8%), while albuminuria (A2 or worse) was present in 164 patients (30.9%). Among 295 patients with available data, 147 (49.8%) had a history of DKA at disease onset. GFR declined by an average of 1.9 per year of disease duration in men and 1.2 in women (p=0.02). Additionally, each additional year of age at diagnosis was associated with a GFR reduction of 2.3 in men and 1.1 in women. The regression model explained 41.4% of GFR variance in men (R²=0.41) and 20.4% in women (R²=0.20). Current HbA1c was the only significant predictor of albuminuria (coefficient 55.1, p=0.008). Patients using the “Carbohydrate Counting” insulin regimen had a higher proportion of normoalbuminuria (A1) compared to those on a fixed basal-bolus regimen (82.0% vs. 66.5%, p=0.04). Although DKA at disease onset did not significantly impact mean GFR (p=0.492) or albuminuria levels (p=0.421), it modulated CKD progression as disease duration had a slightly greater impact on GFR decline in patients with prior DKA (-1.6 vs. -1.4, p < 0.001), while age at diagnosis had a stronger effect in those without DKA (-1.7 vs. -1.3, p < 0.001).

Conclusion: In T1DM, disease duration, younger age at diagnosis, and male were associated with more pronounced GFR decline, while HbA1c was a predictor of albuminuria. DKA at onset modulated CKD progression, and flexible insulin regimens were related to better albuminuria profiles. These findings highlight important risk factors for kidney disease in T1DM.

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