Diabetes and CKD in the United States Population, 2009–2014

Clinical journal of the American Society of Nephrology: CJASN

Bryan R. Kestenbaum¹  Cassianne Robinson-Cohen¹  Leila R. Zelnick²  Katherine Tuttle³  Patrick J. Heagerty⁴ 

[1] *Kidney Research Institute, Division of Nephrology, and..;*Kidney Research Institute, Division of Nephrology, and..Departments of †Epidemiology and..;*Kidney Research Institute, Division of Nephrology, and..¶Department of Medicine, Group Health Cooperative, Seattle, WA..**Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine,..*Kidney Research Institute, Division of Nephrology, and..;‡Biostatistics, and..

关键词: diabetes;    diabetic nephropathy;    chronic kidney disease;    Epidemiology and outcomes;    albuminuria;    Hemoglobin A, Glycosylated;    Prevalence;    Nutrition Surveys;    Cross-Sectional Studies;    blood pressure;    creatinine;    glomerular filtration rate;    Confidence Intervals;    Linear Models;    Glucose;    Renal Insufficiency, Chronic;    diabetes mellitus;    Blood Pressure Determination;    hypertension;    Albumins;   

DOI  :  10.2215/CJN.03700417

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

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.

【 授权许可】

CC BY