Zelnick LR, et al. - This inquiry was set up to contemplate the associations of diabetes with clinical manifestations of CKD independent of age and BP and, to determine the extent to which diabetes contributes to the overall prevalence of CKD in the United States. Findings reported a substantial contribution of diabetes to the CKD burden in the United States. Essentially, a strong association of diabetes was observed, with both albuminuria and reduced GFR independent of demographics and hypertension.

Methods

• Researchers undertook a cross-sectional study including 15,675 participants in the National Health and Nutrition Examination Surveys from 2009 to 2014.
• Diabetes was defined by use of glucose-lowering medications or hemoglobin A_1c≥6.5%.
• They used the CKD Epidemiology Collaboration formula to calculate eGFR, and measured albumin-to-creatinine ratio in single-void urine samples.
• Furthermore, they used binomial and linear regression and calculated the prevalence of CKD manifestations by diabetes status as well as prevalence ratios, differences in prevalence, and prevalence attributable to diabetes, incorporating data from repeat eGFR and urine albumin-to-creatinine ratio measurements to estimate persistent disease.

Results

• Researchers found that for participants with diabetes (n=2279) versus those without diabetes (n=13,396), the estimated prevalence of any CKD (eGFR<60 ml/min per 1.73 m²; albumin-to-creatinine ratio ≥30 mg/g, or both) was 25% versus 5.3%, respectively; albumin-to-creatinine ratio ≥30 mg/g was 16% versus 3.0%, respectively; albumin-to-creatinine ratio ≥300 mg/g was 4.6% versus 0.3%, respectively; eGFR<60 ml/min per 1.73 m² was 12% versus 2.5%, respectively; and eGFR<30 ml/min per 1.73 m² was 2.4% versus 0.4%, respectively (eachP<0.001).
• Findings also demonstrated that when adjusted for demographics and several aspects of BP, prevalence differences were 14.6% (P<0.001), 10.8% (P<0.001), 4.5% (P<0.001), 6.5% (P<0.001), and 1.8% (P=0.004), respectively.
• In addition, after adjusting for demographics, it was observed that approximately 24% (95% confidence interval, 19% to 29%) of CKD among all United States adults was attributable to diabetes.