Chronic kidney disease in US adults with type 2 diabetes: an updated national estimate of prevalence based on Kidney Disease: Improving Global Outcomes (KDIGO) staging

BMC Research Notes

Marcia FT Rupnow²  Vivienne Zhu¹  Yiting Wang¹  Robert A Bailey² 

[1] Janssen Research & Development, LLC, Titusville, NJ, USA;Janssen Scientific Affairs, LLC, 1000 Route 202 South, Raritan, NJ 08869, USA

关键词: Albuminuria;    Estimated glomerular filtration rate;    Prevalence;    Chronic kidney disease;    Type 2 diabetes mellitus;    Diabetes;   

Others  :  826352
DOI  :  10.1186/1756-0500-7-415

 received in 2014-06-11, accepted in 2014-06-27,  发布年份 2014

【 摘 要 】

Background

Kidney Disease Improving Global Outcomes (KDIGO) 2013 updated the classification and risk stratification of chronic kidney disease (CKD) to include both the level of renal function and urinary albumin excretion (UAE). The update subclassifies the previous category of moderate renal impairment. There is currently limited information on the prevalence of CKD based on this new classification in United States (US) adults with type 2 diabetes mellitus (T2DM). The objective of this study was to provide such estimates, for T2DM both overall and in those ≥ 65 years of age. We used the continuous National Health and Nutrition Examination Survey (NHANES) 1999–2012 to identify participants with T2DM. Estimated glomerular filtration rate (eGFR) and UAE were calculated using laboratory results and data collected from the surveys, and categorized based on the KDIGO classification. Projections for the US T2DM population were based on NHANES sampling weights.

Results

A total of 2915 adults diagnosed with T2DM were identified from NHANES, with 1466 being age ≥ 65 years. Prevalence of CKD based on either eGFR or UAE was 43.5% in the T2DM population overall, and 61.0% in those age ≥ 65 years. The prevalence of mildly decreased renal function or worse (eGFR < 60/ml/min/1.73 m²) was 22.0% overall and 43.1% in those age ≥ 65 years. Prevalence of more severe renal impairment (eGFR < 45 ml/min/1.73 m²) was 9.0% overall and 18.6% in those age ≥ 65 years. The prevalence of elevated UAE (> 30 mg/g) was 32.2% overall and 39.1% in those age ≥ 65 years. The most common comorbidities were hypertension, retinopathy, coronary heart disease, myocardial infarction, and congestive heart failure.

Conclusions

This study confirms the high prevalence of CKD in T2DM, impacting 43.5% of this population. Additionally, this study is among the first to report US prevalence estimates of CKD based on the new KDIGO CKD staging system.

【 授权许可】

   
2014 Bailey et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Koro CE, Lee BH, Bowlin SJ: Antidiabetic medication use and prevalence of chronic kidney disease among patients with type 2 diabetes mellitus in the United States. Clin Ther 2009, 31:2608-2617.
• [2]U.S. Renal Data System: USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2013. [http://www.usrds.org/atlas.aspx webcite]
• [3]Laliberte R, Bookhart B, Vekeman F, Corral M, Duh MS, Bailey RA, Piech CT, Lefebvre P: Direct all-cause health care costs associated with chronic kidney disease in patients with diabetes and hypertension: a managed care perspective. J Manag Care Pharm 2009, 15:312-322.
• [4]Kidney Disease: Improving Global Outcomes (KDIGO) CKD Working Group: KDIGO 2012 clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013, 3(1):1-150.
• [5]National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 5(Suppl 1):S1-S266.
• [6]Go AS, Chertow GM, Fan D, McColloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004, 351:1296-1305.
• [7]Gansevoort RT, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Chronic Kidney Disease Prognosis Consortium: Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts. Kidney Int 2011, 80:93-104.
• [8]Matsushita K, van der Velde M, Astor B, Woodward M, Levey A: Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010, 375:2073-2081.
• [9]American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014, 37(suppl 1):S5-S80.
• [10]NHANES homepage [http://www.cdc.gov/nchs/nhanes.htm webcite]
• [11]Dodd AH, Colby MS, Boye KS, Fahlman C, Kim S, Briefel RR: Treatment approach and HbA1c control among US adults with type 2 diabetes: NHANES 1999–2004. Curr Med Res Opin 2009, 25:1605-1613.
• [12]Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP: Association of biochemical B12 deficiency with metformin therapy and vitamin B12 supplements: the National Health and Nutrition Examination Survey, 1999–2006. Diabetes Care 2012, 35:327-333.
• [13]Doggen K, Nobels F, Scheen AJ, Van Crombrugge P, Van Casteren V, Mathieu C: Cardiovascular risk factors and complications associated with albuminuria and impaired renal function in insulin-treated diabetes. J Diabetes Complications 2013, 27:370-375.
• [14]Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration): A new equation to estimate glomerular filtration rate. Ann Intern Med 2009, 150:604-612.
• [15]Levey AS, Coresh J, Green T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F, Chronic Kidney Disease Epidemiology Collaboration: Using standardized serum creatinine values in the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate. Ann Intern Med 2006, 145:247-254.
• [16]Specifying weighting parameters [http://www.cdc.gov/nchs/tutorials/nhanes/SurveyDesign/Weighting/intro.htm webcite]
• [17]Age standardization and population counts [http://www.cdc.gov/nchs/tutorials/nhanes/NHANESAnalyses/AgeStandardization/age_standardization_intro.htm webcite]
• [18]National health interview survey [http://www.cdc.gov/nchs/nhis/nhis_2010_data_release.htm webcite]
• [19]Plantinga LC, Crews DC, Coresh J, Miller ER, Saran R, Yee J, Hedgeman E, Pavkov M, Eberhardt MS, Williams DE, Powe NR: Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes. Clin J Am Soc Nephrol 2010, 5:673-682.
• [20]Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the United States. JAMA 2007, 298:2038-2047.
• [21]Stevens LA, Schmid CH, Greene T, Zhang YL, Beck GJ, Froissart M, Hamm LL, Mauer M, Navis GH, Steffes MW, Eggers PW, Coresh J, Levey AS: Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) equations for estimating GFR levels above 60 mL/min/1.73 m2. Am J Kidney Dis 2010, 56:486-495.
• [22]Matsushita K, Mahmoodi BK, Woodward M, Embeson JR, Jafar TH, Jee SH, Polkinghorne KR, Shankar A, Smith DH, Tonelli M, Warnock DG, Wen CP, Gansevoort RT, Hemmelgarn BR, Levey AS: Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. JAMA 2012, 307:1941-1951.
• [23]National Kidney Disease Education Program website [http://nkdep.nih.gov/lab-evaluation/gfr/estimating.shtml webcite]
• [24]Incidence of end-stage renal disease among persons with diabetes --- United States, 1990—2002 [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5443a2.htm webcite]
• [25]Lv J, Ehteshami P, Sarnak MJ, Tighiouart H, Jun M, Ninomiya T, Foote C, Rodgers A, Zhang H, Wang H, Strippoli GFM, Perkovic V: Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis. CMAJ 2013, 185:949-957.
• [26]Anouts P, Bolignano D, Nistor I, Bilo H, Gnudi L, Heaf J, van Biesen W: Glucose-lowering drugs in patients with chronic kidney disease: a narrative review on pharmacokinetic properties. [http://ndt.oxfordjournals.org/content/early/2013/12/08/ndt.gft462.long webcite]