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Background: eGFR equations are used to monitor progression of kidney disease, but their performance is incompletely understood in young adults with T1D and preserved GFR. To address this deficit, we compared two eGFR equations (creatinine-based CKD-EPI and modified Schwartz) to mGFR in this population. Methods: GFR based on plasma iohexol clearance was measured in 53 patients (24 males) with T1D, as part of the CAN-SOLVE CKD study Results: Mean age was 20.6±2.1 yrs with mean diabetes duration of 13.1±3.3 yrs. Mean HbA1c and ACR were 8.1±1.3 and 1.6±1.9 mg/mmol, respectively. Mean mGFR was 107.6±15.9 ml/min/1.73 m2. The Schwartz eGFR had a smaller mean bias (5.6 vs. 27.4 ml/min/1.73m2), better accuracy, and overall correlation compared to the CKD-EPI eGFR, while the latter had slightly superior precision. However, both equations were in poor agreement with mGFR. Examination of the Bland Altman plots reveals that, in the lower normal range, the CKD-EPI equation overestimated mGFR. The modified Schwartz equation showed no discernible tendencies. Conclusion: In young adults with T1D and preserved GFR, the modified Schwartz eGFR performed slightly better than CKD-EPI eGFR. Overall, however, both were in poor agreement with mGFR suggesting caution about the use of eGFR as a surrogate outcome in longitudinal studies and emphasizing the need to develop novel equations for this population. Disclosure K. Gaebe: None. C. A. White: None. F. H. Mahmud: Advisory Panel; Self; Insulet Corporation, Lilly Diabetes. J. W. Scholey: None. L. Motran: None. M. Palaganas: None. Y. T. Elia: None. D. Cherney: Other Relationship; Self; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Scientific Affairs, LLC., Lilly Diabetes, Merck & Co., Inc., Mitsubishi-Tanabe, Maze Inc, Prometic, Novo Nordisk, Sanofi. E. B. Sochett: None. Funding Canadian Institutes of Health Research (20R26070); JDRF

High-density lipoprotein (HDL) function may be altered in patients with chronic disease, transforming the particle from a beneficial vasoprotective molecule to a noxious pro-inflammatory equivalent. Adolescents with Type 1 diabetes often have elevated HDL, but its vasoprotective properties and relationship to endothelial function have not been assessed.Seventy adolescents with Type 1 diabetes (age 10-17 years) and 30 age-matched healthy controls supplied urine samples for the measurement of early renal dysfunction (albumin:creatinine ratio; ACR), blood samples for the assessment of cardiovascular risk factors (lipid profiles, HDL functionality, glycaemic control, and inflammatory risk score), and had their conduit artery endothelial function tested using flow-mediated dilation (FMD). HDL-c levels (1.69 ± 0.41 vs. 1.44 ± 0.29mmol/L; P 0.001), and glycated haemoglobin (HbA1c) (8.4 ± 1.2 vs. 5.4 ± 0.2%; P 0.001) were increased in all patients compared with controls. However, increased inflammation and HDL dysfunction were evident only in patients who also had evidence of early renal dysfunction (mean ± standard deviation for high-ACR vs. low-ACR and healthy controls: inflammatory risk score 11.3 ± 2.5 vs. 9.5 ± 2.4 and 9.2 ± 2.4, P 0.01; HDL-mediated nitric-oxide bioavailability 38.0 ± 8.9 vs. 33.3 ± 7.3 and 25.0 ± 7.7%, P 0.001; HDL-mediated superoxide production 3.71 ± 3.57 vs. 2.11 ± 3.49 and 1.91 ± 2.47nmol O2 per 250 000 cells, P 0.05). Endothelial function (FMD) was impaired only in those who had both a high inflammatory risk score and high levels of HDL-c (P 0.05).Increased levels of HDL-c commonly observed in individuals with Type 1 diabetes may be detrimental to endothelial function when accompanied by renal dysfunction and chronic inflammation.