Abstract
BackgroundKidney 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.ResultsA 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.ConclusionsThis 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.
Highlights
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)
Since evidence suggests that the prevalence of reduced GFR, albuminuria, and micro/ macrovascular complications differs between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) [13], we made an effort to identify and exclude those with T1DM
We combined the National Health and Nutrition Examination Survey (NHANES) 1999– 2012 data because none of the linear trend tests for Estimated glomerular filtration rate (eGFR) and Urinary albumin to creatinine ratio (UACR) were statistically significant, and numerical values appeared comparable across these survey cycles
Summary
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). Based on the significant impact of CKD, Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) recommend a focus on early identification of CKD. This early identification may allow for treatment directed at CKD to slow or prevent progression, and treatment of associated complications and comorbidities such as cardiovascular disease [4,5]. The original classification ranged from Stage 1 CKD (defined as normal kidney function with other markers for kidney damage) to Stage 5 CKD (defined as kidney failure) This staging system served to provide clinicians with stage-specific action plans for treatment of CKD and associated comorbidities and complications.
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