Diabetes Independently, Significantly Raises Risk of CKD
Approximately 24% of cases of chronic kidney disease (CKD) among US adults are attributable to diabetes, according to a recent study.
Diabetes is a known cause of CKD. However, the extent to which CKD can be attributed to diabetes vs comorbid conditions, like older age and hypertension, is not yet known.
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For their study, the researchers evaluated 15,675 individuals who had participated in the National Health and Nutrition Examination Surveys from 2009 to 2014. Diabetes was defined as the use of glucose-lowering medications or a hemoglobin A1c of 6.5% or more. CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 ml/min per 1.73 m2, an albumin-to-creatinine ratio of 30 mg/g or more, or both.
The CKD Epidemiology Collaboration formula was used to calculate eGFR, and single-void urine samples were used to measure albumin-to-creatinine ratio. The prevalence of CKD manifestations by diabetes status, prevalence ratios, differences in prevalence, and prevalence attributable to diabetes using binomial and linear regression were calculated. Persistent disease was estimated with data from repeat eGFR and urine albumin-to-creatinine ratio measurements.
A total of 2279 patients had diabetes, and 13,396 did not. The estimated prevalence of any CKD was 25% in patients with diabetes vs 5.3% in those without diabetes. A total of 16.0% of patients with diabetes had an albumin-to-creatinine ratio of 30 mg/g or more, compared with 3.0% of patients without diabetes. The proportion of patients with an albumin-to-creatinine ratio of 300 mg/g or more was 4.6% in those with diabetes vs 0.3% in those without.
An eGFR of less than 60 ml/min per 1.73 m2 was noted in 12% of patients with diabetes vs 2.5% without, and an eGFR of less than 30 ml/min per 1.73 m2 was observed in 2.4% with diabetes vs 0.4% without.
Ultimately, after adjustment, the researchers found that approximately 24% of CKD cases in US adults were attributable to diabetes.
“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,” the researchers concluded.
—Christina Vogt
Reference:
Zelnick LR, Weiss NS, Kestenbaum BR, et al. Diabetes and CKD in the United States population, 2009-2014 [Published online October 20, 2017]. Clin J Am Soc Nephrol. doi:10.2215/CJN.03700417.