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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Pediatr
2018 ; 198
(ä): 247-253.e1
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Social Determinants of Health Are Associated with Markers of Renal Injury in
Adolescents with Type 1 Diabetes
#MMPMID29752172
Cummings LAM
; Clarke A
; Sochett E
; Daneman D
; Cherney DZ
; Reich HN
; Scholey JW
; Dunger DB
; Mahmud FH
J Pediatr
2018[Jul]; 198
(ä): 247-253.e1
PMID29752172
show ga
OBJECTIVE: To examine the relationship between the social determinants of health
and markers of early renal injury in adolescent patients with type 1 diabetes
(T1D). STUDY DESIGN: Renal outcomes included estimated glomerular filtration rate
(eGFR) and albumin-creatinine excretion ratio (ACR). Differences in urinary and
serum inflammatory markers also were assessed in relation to social determinants
of health. Regression analysis was used to evaluate the association between the
Ontario Marginalization Index (ON-Marg) as a measure of the social determinants
of health, patient characteristics, ACR, eGFR, and renal filtration status
(hyperfiltration vs normofiltration). RESULTS: Participants with T1D (n?=?199)
with a mean age of 14.4?±?1.7 years and diabetes duration of 7.2?±?3.1 years were
studied. Mean eGFR was 122.0?±?19.4?mL/min/1.73?m(2). Increasing marginalization
was positively associated with eGFR (P?.0001) but not with ACR (P?=?.605).
Greater marginalization was associated with greater median levels of urinary
interleukin (IL)-2, IL-12 (p40), macrophage-derived chemokine, monocyte
chemoattractant protein-3, and tumor necrosis factor-? and serum IL-2. ON-Marg
was significantly associated with eGFR after we controlled for age, sex, body
mass index z score, ethnicity, serum glucose, and hemoglobin A1c in linear
regression. A similar association between hyperfiltration and ON-Marg score was
observed in multivariable logistic regression. CONCLUSION: Increasing
marginalization is significantly associated with both eGFR and hyperfiltration in
adolescents with T1D and is associated with significant changes in urinary
inflammatory biomarkers. These findings highlight a potentially important
interaction between social and biological determinants of health in adolescents
with T1D.
|*Social Determinants of Health
[MESH]
|Acute Kidney Injury/diagnosis/*etiology
[MESH]
|Adolescent
[MESH]
|Biomarkers/metabolism
[MESH]
|Creatinine/blood
[MESH]
|Diabetes Mellitus, Type 1/*complications/*psychology
[MESH]