Temporal trends in the prevalence of diabetic kidney disease in the United States - PubMed (original) (raw)
Temporal trends in the prevalence of diabetic kidney disease in the United States
Ian H de Boer et al. JAMA. 2011.
Abstract
Context: Diabetes is the leading cause of kidney disease in the developed world. Over time, the prevalence of diabetic kidney disease (DKD) may increase due to the expanding size of the diabetes population or decrease due to the implementation of diabetes therapies.
Objective: To define temporal changes in DKD prevalence in the United States.
Design, setting, and participants: Cross-sectional analyses of the Third National Health and Nutrition Examination Survey (NHANES III) from 1988-1994 (N = 15,073), NHANES 1999-2004 (N = 13,045), and NHANES 2005-2008 (N = 9588). Participants with diabetes were defined by levels of hemoglobin A(1c) of 6.5% or greater, use of glucose-lowering medications, or both (n = 1431 in NHANES III; n = 1443 in NHANES 1999-2004; n = 1280 in NHANES 2005-2008).
Main outcome measures: Diabetic kidney disease was defined as diabetes with albuminuria (ratio of urine albumin to creatinine ≥30 mg/g), impaired glomerular filtration rate (<60 mL/min/1.73 m(2) estimated using the Chronic Kidney Disease Epidemiology Collaboration formula), or both. Prevalence of albuminuria was adjusted to estimate persistent albuminuria.
Results: The prevalence of DKD in the US population was 2.2% (95% confidence interval [CI], 1.8%-2.6%) in NHANES III, 2.8% (95% CI, 2.4%-3.1%) in NHANES 1999-2004, and 3.3% (95% CI, 2.8%-3.7%) in NHANES 2005-2008 (P <.001 for trend). The prevalence of DKD increased in direct proportion to the prevalence of diabetes, without a change in the prevalence of DKD among those with diabetes. Among persons with diabetes, use of glucose-lowering medications increased from 56.2% (95% CI, 52.1%-60.4%) in NHANES III to 74.2% (95% CI, 70.4%-78.0%) in NHANES 2005-2008 (P <.001); use of renin-angiotensin-aldosterone system inhibitors increased from 11.2% (95% CI, 9.0%-13.4%) to 40.6% (95% CI, 37.2%-43.9%), respectively (P <.001); the prevalence of impaired glomerular filtration rate increased from 14.9% (95% CI, 12.1%-17.8%) to 17.7% (95% CI, 15.2%-20.2%), respectively (P = .03); and the prevalence of albuminuria decreased from 27.3% (95% CI, 22.0%-32.7%) to 23.7% (95% CI, 19.3%-28.0%), respectively, but this was not statistically significant (P = .07).
Conclusions: Prevalence of DKD in the United States increased from 1988 to 2008 in proportion to the prevalence of diabetes. Among persons with diabetes, prevalence of DKD was stable despite increased use of glucose-lowering medications and renin-angiotensin-aldosterone system inhibitors.
Conflict of interest statement
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Himmelfarb reported that all honoraria and consulting fees from serving on the Shire Scientific Advisory Board on Outcomes Studies in Hemodialysis Patients and the Nephrion/Cytopheryx Medical Advisory Board are donated to the Kidney Research Institute at the University of Washington; money is paid to his institution (University of Washington) for his consulting work for Genzyme, Lilly, and Thrasos. No other authors reported disclosures.
Figures
Figure. Prevalent Cases of Diabetic Kidney Disease in the United States
Prevalent cases are estimated numbers of persons in the US population and were calculated using National Health and Nutrition Examination Survey sample weighting. Error bars indicate 95% confidence intervals. GFR indicates glomerular filtration rate.
Comment in
- Kidney disease in people with diabetes: the expanding epidemic.
Selvin E, Juraschek SP, Coresh J. Selvin E, et al. Am J Kidney Dis. 2012 Mar;59(3):340-2. doi: 10.1053/j.ajkd.2011.11.016. Epub 2011 Dec 10. Am J Kidney Dis. 2012. PMID: 22154327 Free PMC article. No abstract available.
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