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      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

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          Abstract

          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 m 2) was 22.0% overall and 43.1% in those age ≥ 65 years. Prevalence of more severe renal impairment (eGFR < 45 ml/min/1.73 m 2) 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.

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          Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts.

          Ron T. Gansevoort, Kunihiro Matsushita, Marije van der Velde … (2011)
          Both a low estimated glomerular filtration rate (eGFR) and albuminuria are known risk factors for end-stage renal disease (ESRD). To determine their joint contribution to ESRD and other kidney outcomes, we performed a meta-analysis of nine general population cohorts with 845,125 participants and an additional eight cohorts with 173,892 patients, the latter selected because of their high risk for chronic kidney disease (CKD). In the general population, the risk for ESRD was unrelated to eGFR at values between 75 and 105 ml/min per 1.73 m(2) but increased exponentially at lower levels. Hazard ratios for eGFRs averaging 60, 45, and 15 were 4, 29, and 454, respectively, compared with an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log ESRD risk without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 30, 300, and 1000 mg/g were 5, 13, and 28, respectively, compared with an albumin-to-creatinine ratio of 5. Albuminuria and eGFR were associated with ESRD, without evidence for multiplicative interaction. Similar associations were found for acute kidney injury and progressive CKD. In high-risk cohorts, the findings were generally comparable. Thus, lower eGFR and higher albuminuria are risk factors for ESRD, acute kidney injury and progressive CKD in both general and high-risk populations, independent of each other and of cardiovascular risk factors.
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            Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 mL/min/1.73 m2.

            Lesley Stevens, Christopher H Schmid, Tom Greene … (2010)
            The Modification of Diet in Renal Disease (MDRD) Study equation underestimates measured glomerular filtration rate (GFR) at levels>60 mL/min/1.73 m2, with variable accuracy among subgroups; consequently, estimated GFR (eGFR)>or=60 mL/min/1.73 m2 is not reported by clinical laboratories. Here, performance of a more accurate GFR-estimating equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, is reported by level of GFR and clinical characteristics. Test of diagnostic accuracy. Pooled data set of 3,896 people from 16 studies with measured GFR (not used for the development of either equation). Subgroups were defined by eGFR, age, sex, race, diabetes, prior solid-organ transplant, and body mass index. eGFR from the CKD-EPI and MDRD Study equations and standardized serum creatinine. Measured GFR using urinary or plasma clearance of exogenous filtration markers. Mean measured GFR was 68+/-36 (SD) mL/min/1.73 m2. For eGFR or=90 mL/min/1.73 m2. Limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI equation is more accurate than the MDRD Study equation overall and across most subgroups. In contrast to the MDRD Study equation, eGFR>or=60 mL/min/1.73 m2 can be reported using the CKD-EPI equation. Copyright (c) 2010 National Kidney Foundation, Inc. All rights reserved.
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              Antidiabetic medication use and prevalence of chronic kidney disease among patients with type 2 diabetes mellitus in the United States.

              Carol E. Koro, Bo Lee, Steve Bowlin (2009)
              The aims of this study were to estimate the proportion of patients with type 2 diabetes mellitus (DM) in the United States with different stages of chronic kidney disease (CKD) and to describe glycemic control and antidiabetic drug use among them. Using data from the Fourth National Health and Nutrition Examination Survey (NHANES IV) for the years 1999 through 2004, we performed a cross-sectional analysis of patients with type 2 DM aged >or=20 years at the time of the survey interview. CKD stages were categorized according to the classification system established by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Anti-diabetic medication use among these patients was described using self-reported survey responses as well as survey medication files. A total of 1462 patients with type 2 DM were included in the analysis. Men and women constituted 48.3% and 51.7% of the study sample, respectively; 15.6% received a DM diagnosis 10 years ago. CKD was present in 39.7% of patients with DM. Mean (SE) glycosylated hemoglobin was lower in more advanced CKD stages, from stage 1 (8.35% [0.23%]) to combined stages 4 and 5 (6.63% [0.15%]). Based on the medication file data, the proportion of patients with CKD using 1 antidiabetic medication was higher as CKD progressed, from 36.3% at stage 1 to 62.9% at stages 4 and 5 (P = 0.007). By self-report, the proportion of patients with CKD using insulin alone was 6.7% at stage 1 and 38.8% at stages 4 and 5 (P < 0.001). The proportion of patients using oral antidiabetic agents alone was 69.0% at stage 1 and 43.4% at stages 4 and 5 (P < 0.001). Our results indicate that 39.7% of adult patients with type 2 DM in the United States had some degree of CKD, as measured in NHANES IV for the years 1999 through 2004. This finding reinforces the need to screen patients with type 2 DM for CKD and to prevent the cascade of events leading to nephropathy by implementing adequate glycemic and blood pressure controls, especially in the early stages of CKD. Our data also reinforce the need for developing more oral antidiabetic therapies for patients with advanced CKD and type 2 DM, because treatment options for this group are limited. Copyright 2009 Excerpta Medica Inc. All rights reserved.
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                Author and article information

                Contributors
                Robert A Bailey
                Yiting Wang
                Vivienne Zhu
                Marcia FT Rupnow
                Journal
                Journal ID (nlm-ta): BMC Res Notes
                Journal ID (iso-abbrev): BMC Res Notes
                Title: BMC Research Notes
                Publisher: BioMed Central
                ISSN (Electronic): 1756-0500
                Publication date Collection: 2014
                Publication date (Electronic): 2 July 2014
                Volume: 7
                Page: 415
                Affiliations
                [1 ]Janssen Scientific Affairs, LLC, 1000 Route 202 South, Raritan, NJ 08869, USA
                [2 ]Janssen Research & Development, LLC, Titusville, NJ, USA
                Article
                Publisher ID: 1756-0500-7-415
                DOI: 10.1186/1756-0500-7-415
                PMC ID: 4091951
                PubMed ID: 24990184
                SO-VID: f3982fc8-c52a-4871-9613-d1ce0569ee9b
                Copyright © Copyright © 2014 Bailey et al.; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 June 2014
                Date accepted : 27 June 2014
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Medicine
                Keywords: diabetes,type 2 diabetes mellitus,chronic kidney disease,prevalence,estimated glomerular filtration rate,albuminuria
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: diabetes, type 2 diabetes mellitus, chronic kidney disease, prevalence, estimated glomerular filtration rate, albuminuria

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