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Diabetic kidney disease prevalence remains stable
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The prevalence of diabetic kidney disease in the United States remained unchanged from 1988 to 2014, but the frequency of albuminuria decreased and the frequency of reduced estimated glomerular filtration rate increased, according to findings published in JAMA.
“It’s important to note that the ‘typical’ presentation of diabetic kidney disease described in older textbooks and literature may no longer be typical,” Ian de Boer, MD, associate professor of medicine at the University of Washington in Seattle, told Endocrine Today. “It’s important to routinely measure serum creatinine and eGFR for patients with diabetes. While the data suggest that better glucose and blood pressure control have reduced albuminuria, they also suggest that these treatments alone are not enough. We need to do more to understand what’s going on in the kidneys of patients with diabetes and develop new, additional treatments to preserve kidney function.”
De Boer and colleagues evaluated data from National Health and Nutrition Examination Survey studies from 1988 to 2014 on 6,251 adults aged at least 20 years with diabetes to determine the clinical manifestations of kidney disease among them.
From 1988 to 2014, there were no significant changes in the prevalence of diabetic kidney disease (28.4% in 1988-1994; 26.2% in 2009-2014), whereas the prevalence of albuminuria decreased from 20.8% to 15.9%, the prevalence of reduced eGFR increased from 9.2% to 14.1% and the prevalence of severely reduced eGFR increased from 1% to 2.7%.
“We observed that the clinical manifestations of kidney disease have changed among U.S. adults with diabetes over the last 30 years,” de Boer told Endocrine Today. “Albuminuria, or elevated levels of albumin in the urine, has traditionally been thought of as the first evidence of kidney damage for people with diabetes. Reduced GFR, or a reduced ability of the kidneys to filter out waste products, has typically been thought of as a late stage of diabetic kidney disease. But from 1988 to 2014, we saw a significant decrease in the prevalence of albuminuria accompanied by a significant increase in reduced GFR. This implies that the clinical course of diabetic kidney disease is shifting, and the diabetic kidney disease that we as physicians are seeing in the clinic has changed. We don’t know exactly why this is happening. It’s likely related at least in part to better glucose control, better blood pressure control, and increased use of renin-angiotensin-system inhibitors. It’s also possible that people with diabetes are living longer and developing different forms of kidney damage compared to what was seen 30 years ago.” – by Amber Cox
Disclosure: de Boer reports various financial ties with Abbott, AbbVie, the American Diabetes Association, Amgen, Bayer, Boehringer Ingelheim, Ironwood, Janssen, the Juvenile Diabetes Research Foundation, the National Heart, Lung, and Blood Institute, and the National Institute of Diabetes and Digestive and Kidney Diseases. Please see the full study for a list of all other authors’ relevant financial disclosures.
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