Abstract
Background: The incidence rates of diabetes mellitus (DM) and chronic kidney disease (CKD) are increasing worldwide and their coexistence can have a large negative impact on clinical outcomes. However, it is unclear how incident DM affects CKD patients. Methods: Incident CKD patients between 2000 and 2013 were identified from the National Health Insurance Research Database of Taiwan; they were classified as non-DM (n = 10,356), pre-existing DM (n = 6982), and incident DM (n = 1103). Non-DM cases were patients who did not develop DM before the end of the observation period. The outcomes of interest were end-stage renal disease (ESRD), mortality, and composite outcome (ESRD or death). The association between the DM groups and clinical outcomes was estimated using the inverse probability of group-weighted (IPW) multivariate-adjusted time-dependent Cox regression models. Results: During the study period of 14 years, 1735 (16.6%) patients in the non-DM group reached ESRD compared with 2168 (31.05%) in the pre-existing DM group and 111 (11.03%) in the incident DM group (p < 0.001). Moreover, 2219 (21.43%) patients in the non-DM group died compared with 1895 (27.14%) in the pre-existing DM group and 303 (27.47%) in the incident DM group (p < 0.001). Compared with the non-DM group, the pre-existing DM group was associated with a higher risk of ESRD [hazard ratio (HR) 2.54; 95% confidence interval (CI 2.43–2.65), death (HR 2.23; 95% CI 2.14–2.33), and a composite outcome (HR 2.29; 95% CI 2.21–2.36). Similarly, incident DM was also associated with a higher risk of ESRD (HR 1.12; 95% CI 1.06–1.19), death (HR 2.48; 95% CI 2.37–2.60), and a composite outcome (HR 1.77; 95% CI 1.70–1.84) compared with the non-DM group. Factors contributing to incident DM included old age, low monthly income, and having hypertension, hyperlipidemia, and ischemic heart disease, while pentoxifylline reduced the risk of incident DM. Conclusion: Similarly to pre-existing DM, CKD patients with incident DM carried a higher risk of ESRD, mortality, and a composite outcome compared with those with non-DM. For those at risk of incident DM, strict monitoring and intervention strategies must be adopted to help improve their clinical outcomes.
Highlights
Chronic kidney disease (CKD) is an important global health issue due to the increased recognition of its progression to end-stage renal disease (ESRD), its high cardiovascular burden, and high mortality rates [1]
To the best of our knowledge, the present study was the first to use Taiwanese nationwide population-based data with proper longitudinal follow-up to investigate the differences in renal outcomes and patient survival among chronic kidney disease (CKD) patients who were stratified by diabetes mellitus (DM) status
The key findings of the present study were as follows: (i) The presence of DM was associated with a higher risk of ESRD, mortality, and composite outcome (ESRD or mortality); (ii) the incident DM group had a mortality risk of all-cause death that was comparable with the pre-existing DM group; (iii) the pre-existing DM group had a higher risk of ESRD and composite outcome compared with the incident DM group
Summary
Chronic kidney disease (CKD) is an important global health issue due to the increased recognition of its progression to end-stage renal disease (ESRD), its high cardiovascular burden, and high mortality rates [1]. A reduced estimated glomerular filtration rate (eGFR) and increased albuminuria have been identified as significant risk factors for all-causes and CVD death in the general population and CKD patients [3,4,5,6] Their co-existence confers to a multiplicative risk of mortality. Conclusion: to pre-existing DM, CKD patients with incident DM carried a higher risk of ESRD, mortality, and a composite outcome compared with those with non-DM. For those at risk of incident DM, strict monitoring and intervention strategies must be adopted to help improve their clinical outcomes
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