Prevalence and severity of chronic kidney disease in a population with type 1 diabetes from a United States health system: a real-world cohort study

Katherine R Tuttle; Christina L Reynolds; Lindsey M Kornowske; Cami R Jones; Radica Z Alicic; Kenn B Daratha; Joshua J Neumiller; Carla Greenbaum; Meda E Pavkov; Fang Xu; O Kenrik Duru; Susanne B Nicholas; Keith C Norris; CURE-CKD Consortium

doi:10.1016/j.lana.2025.101130

Prevalence and severity of chronic kidney disease in a population with type 1 diabetes from a United States health system: a real-world cohort study

Lancet Reg Health Am. 2025 May 15:47:101130. doi: 10.1016/j.lana.2025.101130. eCollection 2025 Jul.

Authors

Katherine R Tuttle^{1

2

3}, Christina L Reynolds¹, Lindsey M Kornowske¹, Cami R Jones¹, Radica Z Alicic^{1

3}, Kenn B Daratha¹, Joshua J Neumiller^{1

4}, Carla Greenbaum⁵, Meda E Pavkov⁶, Fang Xu⁶, O Kenrik Duru⁷, Susanne B Nicholas⁸, Keith C Norris⁸; CURE-CKD Consortium

Affiliations

¹ Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA.
² Nephrology Division and Kidney Research Institute, University of Washington School of Medicine, Seattle, WA, USA.
³ Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
⁴ College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA.
⁵ Center for Intervention Immunology and Diabetes Program, Benaroya Research Institute, Seattle, WA, USA.
⁶ Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁷ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
⁸ Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

Abstract

Background: A contemporary description and estimates for rates of chronic kidney disease (CKD) in type 1 diabetes are needed to inform risk reduction strategies. The study aim was to assess prevalence and severity of CKD based on a population with type 1 diabetes receiving care at a large United States health system.

Methods: Type 1 diabetes was identified through the Providence health system electronic health records during 2013-2022. Prevalent CKD was defined cross-sectionally by ≥ 90-day persistence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m², urine albumin-to-creatinine ratio ≥30 mg/g, or urine protein-to-creatinine ratio ≥0.15 g/g. Multivariable logistic regression models analyzed variable associations with CKD and severe kidney disease (eGFR < 45 mL/min/1.73 m², dialysis, or transplant).

Findings: The study population (N = 23,589) was 48.6% female with a mean ± SD age of 38 ± 17 years. CKD prevalence was 27.1%. Higher odds of CKD were found for females (odds ratio: 1.36 [95% confidence interval]: 1.26-1.47); age 60-79 years (reference 12-17 years; 2.22 [1.83-2.69]); Asian (reference White; 1.71 [1.20-2.44]), Black or African American (1.76 [1.45-2.14]), and Other race (1.33 [1.04-1.71]) populations. CKD odds were higher with hypertension, heart failure, and atherosclerotic cardiovascular disease. Severe kidney disease was present in 10.8% with higher odds among Black or African American (2.08 [1.23-3.54]) and Native Hawaiian or Pacific Islander (2.62 [1.28-5.38]) populations.

Interpretation: CKD was present in nearly one of three persons with type 1 diabetes with higher risks for females, older adults, racial and ethnic minorities, and those with cardiovascular diseases. Severe kidney disease was found in over one-tenth and more likely in Black or African American and Native Hawaiian or Pacific Islander populations. Focus on disproportionately affected groups who may benefit from monitoring and interventions to improve clinical outcomes will be important for public health and health system strategies to reduce risks of CKD and severe kidney disease in type 1 diabetes.

Funding: This work was supported in part by CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264, and in part by Brigham Research Institute.

Keywords: Cardiovascular disease; Diabetic kidney disease; Diversity; Epidemiology; Kidney failure.