More People Getting Kidney Disease Due To Diabetes

Higher Incidence of Diabetic Kidney Disease in United States

During the last 20 years, diabetic kidney disease has become more prevalent in direct proportion to the increased incidence of diabetes during the same period, says a study published in the June 22-29, 2011 issue of the Journal of the American Medical Association (JAMA).

The disorder is often found as a complication of diabetes; DKD (diabetic kidney disease) is the commonest cause of chronic kidney disease in the industrial world. About 40% of diabetes sufferers eventually get DKD. DKD is also the cause of almost 50% of new cases of end-stage renal disease (ESRD) in the US. The study’s authors write, “Over time, the prevalence of DKD may increase due to the expanding size of the diabetes population or decrease due to the implementation of diabetes therapies.”

Trends of incidence of DKD in the US over the last twenty years were examined by Ian H. de Boer, M.D., M.S., of the University of Washington, Seattle, and colleagues; they also assessed changes in the way disease manifested itself in diabetics over that period. Data from the Third National Health and Nutrition Examination Survey (NHANES III) from 1988-1994 (n = 15,073), NHANES 1999-2004 (n = 13,045), and NHANES 2005-2008 (n = 9,588) were included in the study. The diabetic participants were classified by levels of hemoglobin A 1c of 6.5 percent or greater, use of glucose-lowering medications, or both (n = 1,431 in NHANES III; n = 1,443 in NHANES 1999-2004; n=1,280 in NHANES 2005-2008). The definition of DKD used was either (a) diabetes with albuminuria (ratio of urine albumin to creatinine 30 mg/g or greater), or (b) impaired glomerular filtration rate (less than 60 mL/min/1.73 m 2 estimated using the Chronic Kidney Disease Epidemiology Collaboration formula), or both.

It was found that the prevalence of diabetic kidney disease in US changed as follows: 2.2% in 1998-94, 2.8% in 1999-2004, and 3.3% in 2005-2008. With the increase demographically adjusted, the increase rates were 18 percent from 1988-1994 to 1999-2004 and 34 percent from 1988-1994 to 2005-2008. The actual estimated number of people suffering DKD in the US at any given point between 1988-1994 was 3.9 million; this estimated number for 1999-2004 was 5.5 million; for 2005-2008, 6.9 million.

The percentage of diabetics who took medications to lower glucose levels went up from 56.2 to 74.2, while the usage percentage of renin-angiotensin-aldosterone system inhibitors rose from 11.2 to 40.6. Rates of impaired GFR increased from 14.9 percent in 1988-1994 to 17.7 percent in 2005-2008. There was a decrease in incidence of impaired albuminuria, from 27.3% to 23.7% during this time span which was not of statistical significance.

The authors sum up, “In conclusion, DKD has become more prevalent in the U.S. population over the last 2 decades and will likely contribute increasingly to health care costs and mortality. Among persons with diabetes, clinical manifestations of DKD shifted to include more impaired GFR but the prevalence of any DKD did not change despite increased use of diabetes-related medications.”

Source: July Sciencedaily

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