Clustering of Risk Factors in Parents of Patients With Type 1 Diabetes and Nephropathy

Abstract

OBJECTIVE—To assess the impact of parental risk factors for diabetic nephropathy. RESEARCH DESIGN AND METHODS—This cross-sectional study included 2,355 type 1 diabetic patients from the FinnDiane (Finnish Diabetic Nephropathy) study. Diabetic nephropathy was defined as macroalbuminuria (urinary albumin excretion rate >200 μg/min or >300 mg/24 h) or end-stage renal disease. Information was available from 4,676 parents. Parental scores were calculated based on the number of various traits in the parents. RESULTS—Patients with diabetic nephropathy, compared with those without diabetic nephropathy, had a higher prevalence of maternal (41 vs. 35%, P = 0.046) and parental (62 vs. 55%, P = 0.044) hypertension, maternal stroke (7.6 vs. 5.1%, P = 0.044), and maternal (1.4 vs. 0.7%, P = 0.058) and parental (4.3 vs. 2.9%, P = 0.030) type 1 diabetes. If both, compared with none, of the parents had hypertension, the adjusted odds ratio (OR) for diabetic nephropathy in offspring was 1.56 (95% CI 1.13–2.15). The adjusted OR for diabetic nephropathy was 2.13 (1.36–3.33) for the parental hypertension–diabetes score (3–4 vs. 0 points) and 2.13 (1.37–3.33) for the parental hypertension–cardiovascular disease (CVD)–diabetes score (4–6 vs. 0 points). Fathers of patients with diabetic nephropathy, compared with those without diabetic nephropathy, had reduced overall survival (log-rank P = 0.04) and reduced cardiovascular survival (log-rank P = 0.03). CONCLUSIONS—A cluster of parental hypertension, CVD, and diabetes is associated with diabetic nephropathy in type 1 diabetes, as is paternal mortality.