ORIGINAL ARTICLE Kidney failure risk in type 1 vs. type 2 childhood-onset diabetes mellitus Oren Pleniceanu 1,2,3 & Gilad Twig 1,2,4 & Dorit Tzur 1 & Noah Gruber 2,5 & Michal Stern-Zimmer 2,3 & Arnon Afek 2,6 & Tomer Erlich 1,2,7 & Lital Keinan-Boker 8,9 & Karl Skorecki 10 & Ronit Calderon-Margalit 11 & Asaf Vivante 2,3,4 Received: 25 March 2020 /Revised: 29 April 2020 /Accepted: 27 May 2020 # IPNA 2020 Abstract Background Diabetic kidney disease (DKD) is becoming increasingly common among children. We aimed to estimate the risk of end-stage renal disease (ESKD) and mortality among adolescents with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and normal renal function compared with non-diabetics. We hypothesized that childhood onset T1DM vs. T2DM would be associated with a different risk profile for developing ESKD and its complications. Methods A nationwide, population-based, retrospective cohort study, including 1,500,522 adolescents examined for military service between 1967 and 1997, which were classified according to the presence and type of diabetes. Data were linked to the Israeli ESKD registry. Cox proportional-hazards models were used to estimate the hazard ratio (HR) for ESKD. Results At study enrolment, 1183 adolescents had T1DM and 196 had T2DM. ESKD developed in 2386 non-diabetic individuals (0.2%) compared with 72 individuals (6.1%) with T1DM and 8 individuals (4.1%) with T2DM. Participants with T1DM were younger at ESKD onset than participants with T2DM (median age, 36.0 vs. 40.5 years, P < 0.05). In a multivariate model adjusted for age, sex, paternal origin, enrollment year, BMI, and blood pressure, T1DM and T2DM were associated with HR of 36.4 (95% CI 28.3–46.9) and 19.3 (95% CI 9.6–38.8) for ESKD, respectively. Stratification according to sex, ethnicity, immigration, and socioeconomic status did not materially change the HR. During the follow- up period, mortality rates were higher in T2DM as compared with T1DM and controls (8.7 %, 2.2%, and 2.7% respectively). Conclusions T1DM and T2DM in adolescents with normal renal function confer a significantly increased risk for ESKD. T1DM is associated with younger age at ESKD onset while T2DM is associated with higher mortality rate. Keywords Type 1 diabetes mellitus . Type 2 diabetes mellitus . End-stage kidney disease (ESKD) . Chronic kidney disease (CKD) Ronit Calderon-Margalit and Asaf Vivante contributed equally to this work. * Ronit Calderon-Margalit ronitcm@gmail.com; ronitca@hadassah.org.il * Asaf Vivante asafvivante@gmail.com; asaf.vivante@sheba.health.gov.il 1 Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel 2 Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel 3 Department of Pediatrics B and Pediatric Nephrology unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, 5265601 Ramat Gan, Israel 4 Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 5 Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel 6 Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 7 Urology Department, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel 8 Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel 9 School of Public Health, University of Haifa, Haifa, Israel 10 Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel 11 Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel Pediatric Nephrology https://doi.org/10.1007/s00467-020-04631-2