Body-weight Cycling and Risk of Diabetic Kidney Disease in People With Type 1 Diabetes in the DCCT/EDIC Population

CONTEXT: Intraindividual body-weight variability or cycling is associated with increased risk of chronic kidney disease (CKD) in the general population. OBJECTIVE: We conducted a retrospective analysis of data from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) studies to assess association between body-weight cycling and the risk of renal events in type 1 diabetes. METHODS: Four indices of intraindividual body-weight variability were calculated for 1432 participants of DCCT/EDIC taking into account body-weight measurements during the DCCT follow-up (6 ± 2 years). Variability independent of the mean (VIM) was the main index. Six criteria of progression to CKD were studied during DCCT/EDIC follow-up (21 ± 4 years). Hazard ratio (HR) with 95% confidence interval (CI) were computed in Cox analyses for 1 SD of the indices expressed as Z-score. RESULTS: A high VIM was significantly associated with the incidence of a 40% decline in eGFR from baseline values (HR, 1.25; 95% CI, 1.09-1.41; P = .001), doubling of baseline serum creatinine (HR, 1.34; 95% CI, 1.13-1.57; P = .001), CKD stage 3 (HR, 1.36; 95% CI, 1.12-1.63; P = .002), and with a decline in eGFR > 3 mL/min/m2 per year (all analyses adjusted for CKD risk factors at baseline and follow-up, and use of nephroprotective drugs). VIM was also associated with the incidence of moderately and severely increased albuminuria, but associations did not remain significant following adjustment for follow-up covariates. Similar results were observed for the other indices of body-weight cycling. CONCLUSION: Body-weight cycling is significantly associated with an increased risk of kidney events in people with type 1 diabetes, regardless of body mass index and traditional risk factors.