Grant: OG: DAE Databases/cohorts -Indigenous res. in human develop., child/youth health

Youth living with type 2 diabetes (T2D) are at high risk for kidney failure in early adulthood. Clinical practice guidelines for youth with diabetes recommend screening for protein in the urine at diagnosis, which is the first sign of kidney injury. Typically, kidney function based on a blood test (called eGFR) is initially preserved, or accelerated (hyperfiltration) in youth, therefore most pediatric diabetes doctors do not order eGFR tests. There is however concern that hyperfiltration is an important risk factor for long-term kidney damage. More knowledge is needed to provide evidence for testing eGFR in youth. This project will link 2 unique databases of youth with T2D to long-term health data at the Manitoba Centre for Health Policy to follow youth for the development of chronic kidney disease (CKD) or kidney failure (dialysis or transplant). Utilizing the available data, we will develop a risk prediction tool (equation) specific for this population. To develop the most accurate predictive equation, we will compare equations that include different youth characteristics (age, sex, diabetes duration and +/-race) and lab tests including blood sugar control (HbA1c), urine protein (ACR) and eGFR and determine which combination is best at predicting CKD. This is best way to test if eGFR should be part of this equation, or not! The best predictive equation can then be applied to individual youth, to determine the likelihood that they will progress to CKD or kidney failure in 2, 5, or 10 years. We will then map out kidney function changes over time based on risk subgroups. This study is important, as it will provide evidence for ordering eGFR in youth with T2D and most importantly, will allow pediatric diabetes providers to provide more individualized, risk-based care to children. Potential side effects can be minimized for low-risk youth, whereas more intensified treatments can be prioritized for high-risk youth in order to prevent or delay the need for dialysis.