Early Diabetic Kidney Disease Shortens Life Expectancy

Early diabetic kidney disease (DKD)—often clinically expressed as proteinuria—is associated with a 16-year reduction in life expectancy, reports a study from Taiwan in Kidney International.

The prospective cohort study included 512,700 adults participating in a comprehensive health surveillance study between 1994 and 2008. Of these, 9067 patients had early DKD, defined as stage 1 to 3 chronic kidney disease (CKD) based on estimated glomerular filtration rate and/or albuminuria. Another 50,977 patients had early CKD without diabetes and 18,388 had diabetes without CKD. Life expectancy was compared among groups and with the reference group of individuals who had neither diabetes nor CKD.

One-third of those with diabetes had early DKD. Proteinuria was present in 72.3% of subjects with early DKD, compared to 60.8% of nondiabetic subjects with early CKD. Over an average 8 years’ follow-up, all-cause mortality in the early DKD group was three times higher than in the reference group, hazard ratio (HR) 3.16; twice as high as in the early CKD group, HR 2.01; and nearly twice as high in diabetic patients without CKD, HR 1.79. Ninety-eight percent of subjects with early DKD were unaware of their condition.

Life expectancy was 16 years shorter in patients with early DKD, compared to the reference group. Early DKD was also associated with a 10-year reduction in life expectancy compared to diabetes and six years compared to early CKD. The early DKD group had a high rate of lifestyle risk factors such as inactivity and obesity, which greatly amplified the reduction in life expectancy.

Early DKD is potentially controllable and even reversible. However, outside of nephrology specialty care, awareness of this condition is limited.

The study highlights the dramatic reduction in life expectancy associated with early DKD, even compared to nondiabetic CKD or diabetes without kidney involvement. The authors conclude, “[I]dentifying early proteinuria among diabetic patients and realizing the importance of reducing lifestyle risks like inactivity is a clinical challenge, but can save lives” [Wen CP, et al. Diabetes with early kidney involvement may shorten life expectancy by 16 years. Kidney Int 2017; doi: 10.1016/j.kint.2017.01.030].

July 2017 (Vol. 9, Number 6)