P-106: Early diabetic nephropathy and cardiorenal risk in young adults with type 1 diabetes in Kenya

Introduction

Young adults with Type 1 Diabetes (T1D) in low- and middle-income countries face a high burden of early complications, yet data on diabetic nephropathy and its broader determinants remain limited.

Objectives

To evaluate the burden of diabetic nephropathy and its metabolic, cardiovascular, and social determinants among young adults with T1D in Kenya.

Methods

An analytical cross-sectional study was conducted among 164 young adults (18–34 years) with T1D attending four Kenyan diabetes clinics. Data included HbA1c, urinary albumin–creatinine ratio (UACR), lipid profile, cardiac biomarkers (troponin T, NT-proBNP), eGFR, and social determinants of health (SDOH). Multivariable linear regression assessed predictors of UACR, adjusting for age, sex, and diabetes duration.

Results

Mean age was 25 years and mean diabetes duration 7.3 years. Glycemic control was poor (mean HbA1c 11.5%; 81.7% ≥9%). Diabetic nephropathy was present in 28%, with 26% of the affected demonstrating reduced eGFR. Dyslipidemia was common (mean LDL/HDL ratio 2.53; 64% >2), and over one-third had hypertension.

On adjusted analysis, higher UACR was independently associated with longer diabetes duration (β≈0.28, p<0.01), higher HbA1c (β≈0.35, p<0.001), elevated LDL/HDL ratio (β≈0.22, p=0.02), elevated NT-proBNP and troponin T (p<0.05), greater economic instability (SDOH domain) (β≈0.19, p<0.05).

These highlight a convergence of metabolic, cardiovascular, and socioeconomic risk factors driving early renal injury.

Conclusions

Early diabetic nephropathy is highly prevalent among young adults with T1D in Kenya and is shaped by glycemic, lipid dysregulation and socioeconomic vulnerability. Integrated strategies addressing biomedical and social risk factors are essential to prevent progression of cardiorenal disease.