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Diabetes and CKD in the United States Population, 2009-2014.
Clin J Am Soc Nephrol. 2017 Dec 07; 12(12):1984-1990.CJ

Abstract

BACKGROUND AND OBJECTIVES

Diabetes is an important cause of CKD. However, among people with diabetes, it is unclear to what extent CKD is attributable to diabetes itself versus comorbid conditions, such as advanced age and hypertension. We examined associations of diabetes with clinical manifestations of CKD independent of age and BP and the extent to which diabetes contributes to the overall prevalence of CKD in the United States.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We performed a cross-sectional study of 15,675 participants in the National Health and Nutrition Examination Surveys from 2009 to 2014. Diabetes was defined by use of glucose-lowering medications or hemoglobin A1c ≥6.5%. eGFR was calculated using the CKD Epidemiology Collaboration formula, and albumin-to-creatinine ratio was measured in single-void urine samples. We calculated the prevalence of CKD manifestations by diabetes status as well as prevalence ratios, differences in prevalence, and prevalence attributable to diabetes using binomial and linear regression, incorporating data from repeat eGFR and urine albumin-to-creatinine ratio measurements to estimate persistent disease.

RESULTS

For participants with diabetes (n=2279) versus those without diabetes (n=13,396), the estimated prevalence of any CKD (eGFR<60 ml/min per 1.73 m2; albumin-to-creatinine ratio ≥30 mg/g, or both) was 25% versus 5.3%, respectively; albumin-to-creatinine ratio ≥30 mg/g was 16% versus 3.0%, respectively; albumin-to-creatinine ratio ≥300 mg/g was 4.6% versus 0.3%, respectively; eGFR<60 ml/min per 1.73 m2 was 12% versus 2.5%, respectively; and eGFR<30 ml/min per 1.73 m2 was 2.4% versus 0.4%, respectively (each P<0.001). Adjusting for demographics and several aspects of BP, prevalence differences were 14.6% (P<0.001), 10.8% (P<0.001), 4.5% (P<0.001), 6.5% (P<0.001), and 1.8% (P=0.004), respectively. Approximately 24% (95% confidence interval, 19% to 29%) of CKD among all United States adults was attributable to diabetes after adjusting for demographics.

CONCLUSIONS

Diabetes is strongly associated with both albuminuria and reduced GFR independent of demographics and hypertension, contributing substantially to the burden of CKD in the United States.

Authors+Show Affiliations

Kidney Research Institute, Division of Nephrology, and lzelnick@nephrology.washington.edu.Departments of Epidemiology and.Kidney Research Institute, Division of Nephrology, and. Departments of Epidemiology and.Kidney Research Institute, Division of Nephrology, and. Departments of Epidemiology and.Biostatistics, and.Kidney Research Institute, Division of Nephrology, and. Providence Health Care, Spokane, WA; and. Institute of Translational Health Sciences, University of Washington, Seattle, WA.Department of Medicine, Group Health Cooperative, Seattle, WA.Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine.Kidney Research Institute, Division of Nephrology, and. Departments of Epidemiology and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29054846

Citation

Zelnick, Leila R., et al. "Diabetes and CKD in the United States Population, 2009-2014." Clinical Journal of the American Society of Nephrology : CJASN, vol. 12, no. 12, 2017, pp. 1984-1990.
Zelnick LR, Weiss NS, Kestenbaum BR, et al. Diabetes and CKD in the United States Population, 2009-2014. Clin J Am Soc Nephrol. 2017;12(12):1984-1990.
Zelnick, L. R., Weiss, N. S., Kestenbaum, B. R., Robinson-Cohen, C., Heagerty, P. J., Tuttle, K., Hall, Y. N., Hirsch, I. B., & de Boer, I. H. (2017). Diabetes and CKD in the United States Population, 2009-2014. Clinical Journal of the American Society of Nephrology : CJASN, 12(12), 1984-1990. https://doi.org/10.2215/CJN.03700417
Zelnick LR, et al. Diabetes and CKD in the United States Population, 2009-2014. Clin J Am Soc Nephrol. 2017 Dec 7;12(12):1984-1990. PubMed PMID: 29054846.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetes and CKD in the United States Population, 2009-2014. AU - Zelnick,Leila R, AU - Weiss,Noel S, AU - Kestenbaum,Bryan R, AU - Robinson-Cohen,Cassianne, AU - Heagerty,Patrick J, AU - Tuttle,Katherine, AU - Hall,Yoshio N, AU - Hirsch,Irl B, AU - de Boer,Ian H, Y1 - 2017/10/20/ PY - 2017/04/05/received PY - 2017/08/29/accepted PY - 2017/10/22/pubmed PY - 2018/7/28/medline PY - 2017/10/22/entrez KW - Albumins KW - Blood Pressure Determination KW - Confidence Intervals KW - Cross-Sectional Studies KW - Epidemiology and outcomes KW - Glucose KW - Hemoglobin A, Glycosylated KW - Linear Models KW - Nutrition Surveys KW - Prevalence KW - Renal Insufficiency, Chronic KW - albuminuria KW - blood pressure KW - chronic kidney disease KW - creatinine KW - diabetes KW - diabetes mellitus KW - diabetic nephropathy KW - glomerular filtration rate KW - hypertension SP - 1984 EP - 1990 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 12 IS - 12 N2 - BACKGROUND AND OBJECTIVES: Diabetes is an important cause of CKD. However, among people with diabetes, it is unclear to what extent CKD is attributable to diabetes itself versus comorbid conditions, such as advanced age and hypertension. We examined associations of diabetes with clinical manifestations of CKD independent of age and BP and the extent to which diabetes contributes to the overall prevalence of CKD in the United States. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a cross-sectional study of 15,675 participants in the National Health and Nutrition Examination Surveys from 2009 to 2014. Diabetes was defined by use of glucose-lowering medications or hemoglobin A1c ≥6.5%. eGFR was calculated using the CKD Epidemiology Collaboration formula, and albumin-to-creatinine ratio was measured in single-void urine samples. We calculated the prevalence of CKD manifestations by diabetes status as well as prevalence ratios, differences in prevalence, and prevalence attributable to diabetes using binomial and linear regression, incorporating data from repeat eGFR and urine albumin-to-creatinine ratio measurements to estimate persistent disease. RESULTS: For participants with diabetes (n=2279) versus those without diabetes (n=13,396), the estimated prevalence of any CKD (eGFR<60 ml/min per 1.73 m2; albumin-to-creatinine ratio ≥30 mg/g, or both) was 25% versus 5.3%, respectively; albumin-to-creatinine ratio ≥30 mg/g was 16% versus 3.0%, respectively; albumin-to-creatinine ratio ≥300 mg/g was 4.6% versus 0.3%, respectively; eGFR<60 ml/min per 1.73 m2 was 12% versus 2.5%, respectively; and eGFR<30 ml/min per 1.73 m2 was 2.4% versus 0.4%, respectively (each P<0.001). Adjusting for demographics and several aspects of BP, prevalence differences were 14.6% (P<0.001), 10.8% (P<0.001), 4.5% (P<0.001), 6.5% (P<0.001), and 1.8% (P=0.004), respectively. Approximately 24% (95% confidence interval, 19% to 29%) of CKD among all United States adults was attributable to diabetes after adjusting for demographics. CONCLUSIONS: Diabetes is strongly associated with both albuminuria and reduced GFR independent of demographics and hypertension, contributing substantially to the burden of CKD in the United States. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/29054846/Diabetes_and_CKD_in_the_United_States_Population_2009_2014_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=29054846 DB - PRIME DP - Unbound Medicine ER -