Progression of early kidney injury in youth with type 2 diabetes: a follow-up analysis from the iCARE Cohort

Abstract

Background Youth with type 2 diabetes (T2D) have high rates of albuminuria and mental health comorbidities. This study’s objective was to describe changes in albuminuria and estimated-GFR over 2 years and determine whether better baseline mental health is associated with decreased progression of albuminuria. Methods The iCARE (improving renal Complications in Adolescents with type 2 diabetes through REsearch) study is a prospective cohort study of youth living with T2D. The main outcomes were urine albumin-to-creatinine ratio (ACR) and estimated-GFR measured at baseline and 2-year follow-up. Mediators of interest were measures of mental health assessed using the Kessler Psychological Distress Scale (K6), Perceived Stress Scale (PSS-14), Resilience Scale for Children and Adolescents, and Child and Youth Resilience Measure. Results There were 188 youth with T2D included; 68.1% were female, mean age was 14.2 years (SD 2.2), median HbA1C was 8.9%, and median duration of diabetes was 1.69 years (IQR 0.84–3.08). At baseline, 17.2% had significant psychological distress (K6 ≥13) and 54.6% significant perceived stress scores (≥27 on PSS-14). There were 27.1% with albuminuria (ACR ≥ 3mg/mmol) at baseline and 31.9% at 2-year follow-up. At 2-years, 59% had normal ACR, 10% regressed, 15% persisted, and 17% progressed. Median estimated-GFR was 143.2 mL/min/1.73m² (IQR 131.4-156.8) at baseline (N = 186) and 142.4 mL/min/1.73m² (IQR 128.2-155.3) at 2-year follow-up (N = 175). Measures of mental health scores were not associated with changes in albuminuria. 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 significantly associated with albuminuria, further research is required to explore impacts of mental health in youth with T2D.