Abstract
BackgroundDiabetes-related kidney disease is associated with end-stage renal disease and mortality, but opportunities remain to quantify its association with cardiovascular and non-cardiovascular morbidity outcomes.MethodsWe used the Truven Health MarketScan Commercial Claims and Encounters Database, 2010–2014, which includes specific health services records for employees and their dependents from a selection of large employers, health plans, and government and public organizations. We used administrative claims data to quantify the association between diabetes-related kidney disease and end-stage renal disease, myocardial infarction, congestive heart failure, stroke, and infections. Cox proportional hazard regression models were used to estimate adjusted hazard ratios of developing complications.ResultsAmong 2.2 million patients with diabetes, 7.1% had diabetes-related kidney disease: 13.5%, stage 1–2; 33.8%, stage 3; 13.2% stages 4–5; 39.5%, unknown stage. In multivariable Cox proportional hazard models adjusted for demographic characteristics, baseline comorbid conditions, and total hospital days during the baseline period, hazard ratios for each outcome increased with greater diabetes-related kidney disease severity (stage 1–2 vs. stage 4–5) compared with no diabetes-related kidney disease: myocardial infarction, 1.2 (95% confidence interval 1.1–1.4) and 3.1 (2.9–3.4); congestive heart failure, 1.7 (1.6–1.9) and 5.6 (5.3–5.8); stroke, 1.3 (1.2–1.5) and 2.3 (2.1–2.5); infection, 1.4 (1.3–1.5) and 2.9 (2.8–3.0). Among patients with stage 4–5 disease, 36-month cumulative incidence was nearly 22.8% for congestive heart failure, and 25.8% for infections.ConclusionsDiabetes-related kidney disease appears to be formally diagnosed at a more advanced stage than might be expected, given clinical practice guidelines. Risks of cardiovascular and non-cardiovascular outcomes are high.
Highlights
Type 2 diabetes is one of the cardinal threats to public health, with approximately 422 million individuals affected worldwide as of 2014 [1]
Individuals with diabetes-related kidney disease (DKD) were older than those with diabetes and no kidney disease, but we found no clear trend of increasing age with kidney disease stage
Using a contemporary sample comprising more than 2.2 million patients with diabetes, we found that more than 3 out of 4 patients identified as having DKD were at stage 3 or higher at diagnosis, suggesting that formal identification occurs most often in patients with lower estimated glomerular filtration rate (eGFR), well after pathophysiologic changes are likely to have begun in the kidney
Summary
Type 2 diabetes is one of the cardinal threats to public health, with approximately 422 million individuals affected worldwide as of 2014 [1]. In patients with type 2 diabetes, the association of kidney disease with mortality has recently been quantified [5]. Wetmore et al BMC Endocrine Disorders (2019) 19:89 dataset. To investigate these questions, we created a large retrospective cohort of patients enrolled in an employer group health plan (EGHP) to calculate incidence and prevalence of DKD and the associated risks of ESRD, myocardial infarction (MI), congestive heart failure (CHF), stroke, and infection. We elected to study infection because of evidence that diabetes is associated with this outcome [6, 7]; as such, we reasoned that it would serve as an informative counterpoint to cardiovascular disease-related outcomes. Diabetes-related kidney disease is associated with end-stage renal disease and mortality, but opportunities remain to quantify its association with cardiovascular and non-cardiovascular morbidity outcomes
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