As Diabetes Increases, So Does Diabetic Kidney Disease

Over the past two decades, the rates of diabetic kidney disease (DKD) in the United States have increased in proportion to the rising prevalence of diabetes, reports a study published in the Journal of the American Medical Association.

The researchers analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988 to 1994, NHANES 1999–2004, and NHANES 2005–2008. On the basis of hemoglobin A1c level and use of glucose-lowering drugs, diabetes was present in 8.2 percent of individuals in NHANES III, 11.1 percent in NHANES 1999–2004, and 13.4 percent in NHANES 2005–2008.

On the basis of a urine albumin-to-creatinine ratio of 30 mg/g or higher and/or a GFR of less than 60 mL/min per 1.73 m2, the prevalence of DKD was 2.2 percent in 1988–1994, 2.8 percent in 1999–2004, and 3.3 percent in 2005–2008. This trend reflected the rising prevalence of diabetes; among individuals with diabetes, the proportion with DKD was unchanged. The use of glucose-lowering drugs by diabetic individuals increased from 56.2 percent in NHANES III to 74.2 percent in NHANES 2005–2008. The use of renin-angiotensin-aldosterone system inhibitors increased from 11.2 percent to 40.6 percent.

The percentage of diabetic individuals with impaired GFR increased significantly, from 14.9 percent to 17.7 percent. The albuminuria rate decreased nonsignificantly, from 27.3 percent to 23.7 percent.

These cross-sectional NHANES data show an increase in DKD in proportion to the rising prevalence of diabetes in the United States. Among people with diabetes, the prevalence of DKD has remained about the same, despite increased use of diabetes therapies. The researchers write, “[A]dditional interventions are needed to prevent the development of diabetes and to target GFR loss once diabetes is diagnosed.” [de Boer IH, et al. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA 2011; 305:2532–2539].

September 2011 (Vol. 3, Number 9)