Abstract
BackgroundTo evaluate the characteristics of type 2 diabetes (T2DM) patients with or without chronic kidney disease (CKD) in Germany.MethodsUsing combined DPV/DIVE registry data, the analysis included patients with T2DM at least ≥ 18 years old who had an estimated glomerular filtration rate (eGFR) value available. CKD was defined as an eGFR < 60 mL/min/1.73 m2 or eGFR ≥ 60 mL/min/1.73 m2 and albuminuria (≥ 30 mg/g). Median values of the most recent treatment year per patient are reported.ResultsAmong 343,675 patients with T2DM 171,930 had CKD. Patients with CKD had a median eGFR of 48.9 mL/min/1.73 m2 and 51.2% had a urinary albumin level ≥ 30 mg/g. They were older, had a longer diabetes duration and a higher proportion was females compared to patients without CKD (all p < 0.001). More than half of CKD patients (53.5%) were receiving long-acting insulin-based therapy versus around 39.1% of those without (p < 0.001). CKD patients also had a higher rate of hypertension (79.4% vs 72.0%; p < 0.001). The most common antihypertensive drugs among CKD patients were renin-angiotensin-aldosteron system inhibitors (angiotensin converting enzyme inhibitors 33.8%, angiotensin receptor blockers 14.2%) and diuretics (40.2%). CKD patients had a higher rate of dyslipidemia (88.4% vs 86.3%) with higher triglyceride levels (157.9 vs 151.0 mg/dL) and lower HDL-C levels (men: 40.0 vs 42.0 mg/dL; women: 46.4 vs 50.0 mg/dL) (all p < 0.001) and a higher rate of hyperkalemia (> 5.5 mmol/L: 3.7% vs. 1.0%). Comorbidities were more common among CKD patients (p < 0.001).ConclusionThe results illustrate the prevalence and morbidity burden associated with diabetic kidney disease in patients with T2DM in Germany. The data call for more attention to the presence of chronic kidney disease in patients with diabetes, should trigger intensified risk factor control up and beyond the control of blood glucose and HbA1c in these patients. They may also serve as a trigger for future investigations into this patient population asking for new treatment options to be developed.
Highlights
To evaluate the characteristics of type 2 diabetes (T2DM) patients with or without chronic kidney disease (CKD) in Germany
type-2 diabetes mellitus (T2DM) patients with CKD were more likely than those without CKD to be treated by a hospital-based physician (68.5% vs 59.7%, p < 0.001), were older than those without CKD, had a longer median duration of diabetes (10.3 vs 7.2 years, p < 0.001), and were more likely to be female (52.4% vs 42.0%, p < 0.001)
Patients with CKD had a higher rate of hypertension (79.4% vs 72.0%, p < 0.001), they were more likely to be receiving antihypertensive drugs (62.6% vs 20.7%, p < 0.001) and their median blood pressure (BP) value was lower than those for patients without CKD (Table 1)
Summary
To evaluate the characteristics of type 2 diabetes (T2DM) patients with or without chronic kidney disease (CKD) in Germany. The prevalence of chronic kidney disease (CKD) has increased in recent decades alongside an increase in diabetes and hypertension, the main drivers of CKD [1]. Kidney disease attributable to diabetes mellitus (diabetic kidney disease; DKD) is one of the most common complications of diabetes and affects approximately 40% of patients with type 2 diabetes (T2DM) [2, 3]. The prevalence of T2DM is increasing worldwide [8, 9] and diabetes-associated CKD is a major contributor to the global burden of disease [4]. In Germany it is estimated that up to 10% of people have been diagnosed with T2DM [11,12,13,14] and approximately 40% of individuals with T2DM have comorbid CKD [15]
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