Background  
According to Taiwan’s National Health insurance (NHI) medical clAims (1999-2012), the cumulative incidence of nephropathy after 12 years following T1DM diagnosis was 30.2%.(1 ) In another Taiwan's NHI claims (2000-2016), the prevalence of CKD within type 1 DM patients increased from 10.78% to 20.44% in male and 12.24% to 22.14% in female.(2) The proportion of dialysis and renal transplantation became prevalent within these patients(2). Also, For incident reduced eGFR (&lt;60 mL/min/1.73 m2), higher mean HbA1c followed by higher mean triglycerides, older age, and higher systolic BP were the most significant factors in a 27 yr-follow up in the Diabetes Control and Complications Trial (DCCT) cohort.( 3)

  
Aim  
To identify risk factors of diabetic kidney disease (DKD) in type 1 DM patients. 

Method  
We conducted a cross-sectional study by obtaining questionnaires from type 1 DM patients who has registered in Taiwan Diabetes Registry Study from 2015 to 2018. The definition of DKD is based on clinical guideline for diabetic management in chronic kidney disease (KDIGO 2020)( 4). Student’s t-test and Chi-square test were used to compare the difference of various parameters between patients with and without DKD. Pearson correlation was used to identify the association of various continuous variables with eGFR. Logistic regression was applied to identify DKD risk factors, and multivariable linear regression was conducted to identify the factors associated with eGFR.

Results  
A total of 1086 type 1 DM patients were enrolled in our study, and 459 (42.3%) were defined as DKD, with median age 32 years (interquartile range, 22 to 41 y/o) and female predominant (57.3%). The type 1 DM patients with DKD had higher BMI, higher systolic BP &amp; diastolic BP, higher waist and HbA1C, longer disease duration, lower education level, higher percentage with family history of DM &amp; hypertension, higher percentage with diabetes retinopathy, inpatient history within 3 years, and higher percentage of using ACEI/ARB. According to logistic regression model, lower education level, family history of DM, higher diastolic BP, diabetes retinopathy and use of ARB were independent risk factors associated with DKD. According to multiple regression model, disease duration, use of ARB, education level, HbA1c, diabetes retinopathy, inpatient history within 3 years, and SBP were independently associated with eGFR. 

Discussion  
In our study, conventional risk factors including higher mean HbA1c, higher systolic BP are associated with higher odds of DKD, while triglyceride showed non-significant association. Diabetic retinopathy is also associated with DKD, indicating microvascular complications of diabetes shoud be reviewed throughly in clinical setting. We also found only 3.1% and 10.3% T1DM patients with DKD receiving ACEI or ARB, respectively, and the administration of ACEI or ARB will be strongly recommended in patients with DKD to fulfill the standard of care in DKD patients.  


References  
1. Ou HT, et al. BMJ Open 2017;7:e015117  
2. Taiwan diabetes registry, type 1 diabetes (2020), pp.53-pp.71   
3. Perkins BA, et al. Diabetes Care 2019;42:883-890.  
4. Kidney International (2020) 98, S1–S115



Background
According to Taiwan’s National Health insurance (NHI) medical clAims (1999-2012), the cumulative incidence of nephropathy after 12 years following T1DM diagnosis was 30.2%.(1 ) In another Taiwan's NHI claims (2000-2016), the prevalence of CKD within type 1 DM patients increased from 10.78% to 20.44% in male and 12.24% to 22.14% in female.(2) The proportion of dialysis and renal transplantation became prevalent within these patients(2). Also, For incident reduced eGFR (<60 mL/min/1.73 m2), higher mean HbA1c followed by higher mean triglycerides, older age, and higher systolic BP were the most significant factors in a 27 yr-follow up in the Diabetes Control and Complications Trial (DCCT) cohort.( 3)
Aim
To identify risk factors of diabetic kidney disease (DKD) in type 1 DM patients.
Method
We conducted a cross-sectional study by obtaining questionnaires from type 1 DM patients who has registered in Taiwan Diabetes Registry Study from 2015 to 2018. The definition of DKD is based on clinical guideline for diabetic management in chronic kidney disease (KDIGO 2020)( 4). Student’s t-test and Chi-square test were used to compare the difference of various parameters between patients with and without DKD. Pearson correlation was used to identify the association of various continuous variables with eGFR. Logistic regression was applied to identify DKD risk factors, and multivariable linear regression was conducted to identify the factors associated with eGFR.
Results
A total of 1086 type 1 DM patients were enrolled in our study, and 172 (15.2%) were defined as DKD, with median age 35.6 years (interquartile range, 22 to 41 y/o) and female predominant (56.8%). The type 1 DM patients with DKD had elder age, longer disease duration, lower percentage of care in medical center, family history of DM and CKD, chewing betel nut, higher systolic BP and diastolic BP, higher waist, HbA1C and total cholesterol, complicated with diabetes retinopathy, having hypertension and hyperlipidemia, inpatient history within 3 years, and higher percentage of using ACEI/ARB. According to logistic regression model, frequency of insulin injection, SBP, diabetes retinopathy and use of ACEI/ARB were independent risk factors associated with DKD. According to multiple regression model, disease duration, HbA1c, diabetes retinopathy, betel nut chewing, frequency of insulin injection, inpatient history within 3 years, and SBP were independently associated with eGFR.
Discussion
In our study, conventional risk factors including higher mean HbA1c, higher systolic BP are associated with higher odds of DKD, while triglyceride showed non-significant association. Diabetic retinopathy is also associated with DKD, indicating microvascular complications of diabetes should be reviewed thoroughly in a clinical setting. We also found only 6.4% and 20.6% T1DM patients with DKD receiving ACEI or ARB, respectively and the administration of ACEI or ARB will be strongly recommended in patients with DKD to fulfill the standard of care in DKD patients.

References
1. Ou HT, et al. BMJ Open 2017;7:e015117
2. Taiwan diabetes registry, type 1 diabetes (2020), pp.53-pp.71
3. Perkins BA, et al. Diabetes Care 2019;42:883-890.
4. Kidney International (2020) 98, S1–S115

The epidemiologic investigation and risk factor analysis of dibetic kidney disease among type 1 DM patients in Taiwan