Progression of Early Kidney Injury in Youth With Type 2 Diabetes: A Follow-Up Analysis From the Canadian iCARE Cohort
Anna Liu, Elizabeth Sellers, Jon McGavock, Melissa Del Vecchio, Stephanie Goguen, Brandy Wicklow, Allison DartBackground
Youth with type 2 diabetes (T2D) have high rates of albuminuria, the earliest marker of kidney injury in youth with T2D. Later stages of diabetic kidney disease are characterized by increasing albuminuria and declining estimated glomerular filtration rate (eGFR). Mental health and stress have been endorsed as important barriers to wellness by youth living with T2D. Previous evidence has supported the association between albuminuria and stress in youth with T2D, however, the temporal nature of these associations have not been assessed.
Objective
This study’s objective is to describe change in albuminuria and eGFR over 2-year follow up and evaluate the association between mental health and albuminuria and eGFR over time. We hypothesized lower levels of stress and distress would be associated with lower rates of albuminuria progression and hyperfiltration.
Methods
A substudy of the The iCARE (Improving Renal Complications in Adolescents with Type 2 Diabetes through REsearch) prospective cohort of youth with T2D. Main outcomes include albumin to creatinine ratio (ACR) and eGFR at baseline and 2-year follow-up. Main mental health exposures were assessed using the Kessler Psychological Distress Scale (K6), Perceived Stress Scale (PSS-14), and Resilience Scale for Children and Adolescents (RSCA). Analyses include descriptive statistics as well as logistic regression models for persistence/progression of albuminuria and linear mixed-effects model analyses for urine ACR and eGFR.
Results
Of the 188 youth included, 68.1% were female, mean age 14.2 years (SD 2.2), median HbA1C was 8.9% (IQR 5.0-14.9), and median duration of diabetes was 1.7 years (IQR 0.8-3.1). At baseline, 17.2% had significant distress (K6 ≥13) and 54.6% significant stress (≥27 on PSS-14). Twenty-seven percent had albuminuria (ACR ≥3mg/mmol or ≥30mg/g) at baseline. At 2-year follow up, 59% had normal ACR, 10% regressed, 15% persisted, and 17% progressed. Median eGFR was 143.2mL/min/1.73m 2 (IQR 131.4-156.8) at baseline and 142.4mL/min/1.73m 2 (IQR 128.2-155.3) at 2-year follow-up. Mental health scores were not associated with changes in albuminuria or eGFR over time.
Conclusions
High rates of albuminuria, stress and distress were observed at baseline and 2-year follow-up in youth with T2D. While mental health was not associated with albuminuria or eGFR, this study highlights the importance of screening for comorbid mental health challenges in clinical settings.