IDF21-0591 Trends in Prevalence of Chronic Kidney Disease and Treatment Goals in Diabetes among US Adults, 1999–2018

Abstract

Background: Diabetes is the leading cause of chronic kidney disease (CKD), the latter affecting 50% of patients with type 2 diabetes in the United States (US). Understanding population-wide trends in the prevalence of CKD and treatment goals in diabetes is critical to planning public health approaches for the prevention and management of CKD in diabetes. Aim: To determine trends in the prevalence of CKD, its risk factors, and diabetes treatment goals among US adults with diabetes between 1999–2000 and 2017–2018. Method: Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999–2000 and 2017–2018 were included. The sample included adults aged 20 years or older who had self-reported diagnosed diabetes. CKD was defined based on urine albumin-to-creatinine ratio ≥30 mg/g or estimated-glomerular filtration rate (eGFR) <60 mL/min/1.73m2. Diabetes treatment goals included HbA1c <8.0% (HbA1c target), blood pressure <130/80 mmHg (BP target), and total cholesterol <240 mg/dL (TC target). We estimated age- and sex-standardized prevalence of CKD in diabetes by sociodemographic characteristics and diabetes treatment goals. Logistic regressions were used to explore the associations of risk factors with the prevalence of CKD. Results: Amongst 5,976 participants with diabetes eligible for this analysis (mean age, 62.1 years; 51.5% men), the estimated standardized prevalence of CKD in diabetes decreased from 48.3% (95% CI: 47.9%, 48.6%) in 1999–2000 to 46.4% (46.2%, 46.5%) in 2017–2018 (average annual percentage changes, AAPC=−0.9 [−1.8, 0.0]). The main decreasing in prevalence of CKD occurred in women (AAPC=−1.2 [−2.1, −0.3]). The prevalence of CKD was 41% and 51% among patients with and without achieving HbA1c target in 2017–2018. The respectively figures were 37% and 54% for BP target, 45% and 47% for TC target. The youngest patients (20–39 years) achieved diabetes treatment of HbA1c and BP targets had lowest prevalence of CKD. Association analysis suggested that patients with achieving targets of BP (adjusted odds ratio, OR= 0.86 [0.81, 0.91]), HbA1c (OR= 0.88 [0.82, 0.94]), and two or all three of treatment goals (OR=0.77 [0.66, 0.90] and OR=0.70 [0.60, 0.82]) were less likely present CKD. Discussion: Based on NHANES data from US adults, the estimated prevalence of CKD in diabetes decreased between 1999–2000 and 2017–2018. The young patients with diabetes had a low percentage of achieving diabetes treatment targets. The reduced risk association of achieving diabetes treatment targets with the prevalence of CKD was more robust among the young patients calls for targeted action.