{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T07:30:14Z","timestamp":1784619014566,"version":"3.55.0"},"reference-count":28,"publisher":"American Diabetes Association","issue":"1","license":[{"start":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T00:00:00Z","timestamp":1545264000000},"content-version":"vor","delay-in-days":31,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/100008871","name":"JDRF","doi-asserted-by":"publisher","award":["17-2013-8"],"award-info":[{"award-number":["17-2013-8"]}],"id":[{"id":"10.13039\/100008871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 DK036836"],"award-info":[{"award-number":["P30 DK036836"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["AG-024824"],"award-info":[{"award-number":["AG-024824"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["DK-041526"],"award-info":[{"award-number":["DK-041526"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015736","name":"Folkh\u00e4lsan Research Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015736","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010113","name":"Wilhelm and Else Stockmann Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100010113","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Liv och H\u00e4lsa Society"},{"name":"Helsinki University Central Hospital Research Funds"},{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"crossref","award":["275614"],"award-info":[{"award-number":["275614"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"crossref","award":["299200"],"award-info":[{"award-number":["299200"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,1,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>Patients with type 1 diabetes and diabetic nephropathy are targets for intervention to reduce high risk of end-stage renal disease (ESRD) and deaths. This study compares risks of these outcomes in four international cohorts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>In the 1990s and early 2000s, Caucasian patients with type 1 diabetes with persistent macroalbuminuria in chronic kidney disease stages 1\u20133 were identified in the Joslin Clinic (U.S., 432), Finnish Diabetic Nephropathy Study (FinnDiane) (Finland, 486), Steno Diabetes Center Copenhagen (Denmark, 368), and INSERM (France, 232) and were followed for 3\u201318 years with annual creatinine measurements to ascertain ESRD and deaths unrelated to ESRD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>During 15,685 patient-years, 505 ESRD cases (rate 32\/1,000 patient-years) and 228 deaths unrelated to ESRD (rate 14\/1,000 patient-years) occurred. Risk of ESRD was associated with male sex; younger age; lower estimated glomerular filtration rate (eGFR); higher albumin\/creatinine ratio, HbA1c, and systolic blood pressure; and smoking. Risk of death unrelated to ESRD was associated with older age, smoking, and higher baseline eGFR. In adjusted analysis, ESRD risk was highest in Joslin versus reference FinnDiane (hazard ratio [HR] 1.44, P = 0.003) and lowest in Steno (HR 0.54, P &amp;lt; 0.001). Differences in eGFR slopes paralleled risk of ESRD. Mortality unrelated to ESRD was lowest in Joslin (HR 0.68, P = 0.003 vs. the other cohorts). Competing risk did not explain international differences in the outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Despite almost universal renoprotective treatment, progression to ESRD and mortality in patients with type 1 diabetes with advanced nephropathy are still very high and differ among countries. Finding causes of these differences may help reduce risk of these outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc18-1369","type":"journal-article","created":{"date-parts":[[2018,11,19]],"date-time":"2018-11-19T16:30:42Z","timestamp":1542645042000},"page":"93-101","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":46,"title":["Variations in Risk of End-Stage Renal Disease and Risk of Mortality in an International Study of Patients With Type 1 Diabetes and Advanced Nephropathy"],"prefix":"10.2337","volume":"42","author":[{"given":"Jan","family":"Skupien","sequence":"first","affiliation":[{"name":"Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland"},{"name":"Research Division, Joslin Diabetes Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam M.","family":"Smiles","sequence":"additional","affiliation":[{"name":"Research Division, Joslin Diabetes Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erkka","family":"Valo","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Institute of Genetics, Folkh\u00e4lsan Research Center; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital; and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarunveer S.","family":"Ahluwalia","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Gyorgy","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, Universit\u00e9 Pierre-et-Marie-Curie (UPMC) Paris 06 INSERM UMR_S 1166, and Department of Genomics and Pathophysiology of Cardiovascular Diseases, Institute of Cardiometabolism and Nutrition, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4322-6942","authenticated-orcid":false,"given":"Niina","family":"Sandholm","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Institute of Genetics, Folkh\u00e4lsan Research Center; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital; and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Croall","sequence":"additional","affiliation":[{"name":"Research Division, Joslin Diabetes Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Lajer","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"McDonnell","sequence":"additional","affiliation":[{"name":"Research Division, Joslin Diabetes Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Forsblom","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Institute of Genetics, Folkh\u00e4lsan Research Center; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital; 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