Normoalbuminuric chronic kidney disease in type 1 diabetes: is it real and is it serious? Reply to Rigalleau V, Blanco L, Alexandre L et al [letter]

Excerpt

To the Editor: We really appreciated the interest and comments by Rigalleau and colleagues on our recent article [1]. We agree that the proportion of individuals with the non-albuminuric (Alb⁻) phenotype with type 1 diabetes and chronic kidney disease (CKD) in our study was surprisingly high (17 out of 29, 58.6%) [2]. This figure is higher than that reported by Thorn et al [3] in the FinnDiane Study (78 out of 502, 15.5%; p < 0.0001, χ² test) and, also, in the DCCT/Epidemiology of Diabetes Interventions and Complications (EDIC) Study [4], in which 23.6% of individuals (21 out of 89; p < 0.001, χ² test) were reported as having normoalbuminuria (albumin excretion rate [AER] ≤ 30 mg/24 h) and estimated GFR (eGFR) < 60 ml min⁻¹ [1.73 m]⁻². Nonetheless, our figure is similar to the one reported in the Renal Insufficiency And Cardiovascular Events (RIACE) Study [5], which enrolled a large cohort of Italian individuals with type 2 diabetes and found that 1673 out of 2959 (56.5%) individuals with eGFR < 60 ml min⁻¹ [1.73 m]⁻² had normoalbuminuria. The reasons for these discrepancies are not readily apparent. Whether local pathogenic background and clinical management could contribute to these differences is a hypothesis that needs to be verified. …