Holly Kramer1,2,3, Robert E Boucher4, David Leehey2,3, Linda Fried5, Guo Wei4, Tom Greene4, Sylvia E Rosas6, Richard Cooper7, Guichan Cao7, Srinivasan Beddhu4,8. 1. Department of Public Health Sciences, Loyola University Chicago, Maywood, IL hkramer@lumc.edu. 2. Division of Nephrology and Hypertension, Department of Medicine, Loyola University Chicago, Maywood, IL. 3. Hines Veterans Affairs Medical Center, Hines, IL. 4. Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT. 5. Veterans Affairs Pittsburgh Healthcare System and Division of Nephrology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA. 6. Joslin Diabetes Center and Division of Nephrology, Department of Medicine, Beth Israel Deaconess Hospital, Boston, MA. 7. Department of Public Health Sciences, Loyola University Chicago, Maywood, IL. 8. Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT.
Abstract
OBJECTIVE: Improved blood pressure control and use of renin-angiotensin-aldosterone system blockers have altered the clinical presentation or phenotype of chronic kidney disease (CKD) in U.S. adults with diabetes. These changes may influence mortality. RESEARCH DESIGN AND METHODS: Data from the National Health and Nutrition Examination Surveys (NHANES) 1988-2006 were used to examine mortality trends in adults with diabetes, defined as physician diagnosis, fasting glucose ≥126 mg/dL, HbA1c >6.5% (48 mmol/mol), or use of glucose-lowering medications. Mortality trends by CKD phenotype (estimated glomerular filtration rate [eGFR] and urine albumin-to-creatinine ratio [ACR] level) were obtained via linkage with the National Death Index through 31 December 2011 while accounting for the complex survey design. RESULTS: From 1988 to 2006, adults with an eGFR <60 mL/min/1.73 m2 and an ACR <30 mg/g increased from ∼0.9 million (95% CI 0.7, 1.1) or 6.6% of the total population with diabetes during years 1988-1994 to 2.4 million (95% CI 1.9, 2.9) or 10.1% of the total population with diabetes during years 2007-2010. Mortality rates generally trended downward for adults with diabetes and an ACR ≥30 mg/g but increased in those with eGFR <60 mL/min/1.73 m2 and an ACR <30 mg/g from 35 deaths per 1,000 person-years (95% CI 22, 55) during years 1988-1994 to 51 deaths per 1,000 person-years (95% CI 33, 83) during years 2003-2006. CONCLUSIONS: ACR values are decreasing in U.S. adults with diabetes, but optimal management strategies are needed to reduce mortality in those with a low eGFR and an ACR <30 mg/g.
OBJECTIVE: Improved blood pressure control and use of renin-angiotensin-aldosterone system blockers have altered the clinical presentation or phenotype of chronic kidney disease (CKD) in U.S. adults with diabetes. These changes may influence mortality. RESEARCH DESIGN AND METHODS: Data from the National Health and Nutrition Examination Surveys (NHANES) 1988-2006 were used to examine mortality trends in adults with diabetes, defined as physician diagnosis, fasting glucose ≥126 mg/dL, HbA1c >6.5% (48 mmol/mol), or use of glucose-lowering medications. Mortality trends by CKD phenotype (estimated glomerular filtration rate [eGFR] and urine albumin-to-creatinine ratio [ACR] level) were obtained via linkage with the National Death Index through 31 December 2011 while accounting for the complex survey design. RESULTS: From 1988 to 2006, adults with an eGFR <60 mL/min/1.73 m2 and an ACR <30 mg/g increased from ∼0.9 million (95% CI 0.7, 1.1) or 6.6% of the total population with diabetes during years 1988-1994 to 2.4 million (95% CI 1.9, 2.9) or 10.1% of the total population with diabetes during years 2007-2010. Mortality rates generally trended downward for adults with diabetes and an ACR ≥30 mg/g but increased in those with eGFR <60 mL/min/1.73 m2 and an ACR <30 mg/g from 35 deaths per 1,000 person-years (95% CI 22, 55) during years 1988-1994 to 51 deaths per 1,000 person-years (95% CI 33, 83) during years 2003-2006. CONCLUSIONS: ACR values are decreasing in U.S. adults with diabetes, but optimal management strategies are needed to reduce mortality in those with a low eGFR and an ACR <30 mg/g.
Authors: Amanda I Adler; Richard J Stevens; Sue E Manley; Rudy W Bilous; Carole A Cull; Rury R Holman Journal: Kidney Int Date: 2003-01 Impact factor: 10.612
Authors: Celine Q F Klessens; Tess D Woutman; Kimberley A M Veraar; Malu Zandbergen; Elisabeth J J Valk; Joris I Rotmans; Ron Wolterbeek; Jan A Bruijn; Ingeborg M Bajema Journal: Kidney Int Date: 2016-04-09 Impact factor: 10.612
Authors: Lesley A Inker; Christopher H Schmid; Hocine Tighiouart; John H Eckfeldt; Harold I Feldman; Tom Greene; John W Kusek; Jane Manzi; Frederick Van Lente; Yaping Lucy Zhang; Josef Coresh; Andrew S Levey Journal: N Engl J Med Date: 2012-07-05 Impact factor: 91.245
Authors: Johannes F E Mann; David D Ørsted; Kirstine Brown-Frandsen; Steven P Marso; Neil R Poulter; Søren Rasmussen; Karen Tornøe; Bernard Zinman; John B Buse Journal: N Engl J Med Date: 2017-08-31 Impact factor: 91.245
Authors: Maryam Afkarian; Michael C Sachs; Bryan Kestenbaum; Irl B Hirsch; Katherine R Tuttle; Jonathan Himmelfarb; Ian H de Boer Journal: J Am Soc Nephrol Date: 2013-01-29 Impact factor: 10.121
Authors: Kunihiro Matsushita; Josef Coresh; Yingying Sang; John Chalmers; Caroline Fox; Eliseo Guallar; Tazeen Jafar; Simerjot K Jassal; Gijs W D Landman; Paul Muntner; Paul Roderick; Toshimi Sairenchi; Ben Schöttker; Anoop Shankar; Michael Shlipak; Marcello Tonelli; Jonathan Townend; Arjan van Zuilen; Kazumasa Yamagishi; Kentaro Yamashita; Ron Gansevoort; Mark Sarnak; David G Warnock; Mark Woodward; Johan Ärnlöv Journal: Lancet Diabetes Endocrinol Date: 2015-05-28 Impact factor: 32.069
Authors: Stephen Zewinger; Thomas Rauen; Michael Rudnicki; Giuseppina Federico; Martina Wagner; Sarah Triem; Stefan J Schunk; Ioannis Petrakis; David Schmit; Stefan Wagenpfeil; Gunnar H Heine; Gert Mayer; Jürgen Floege; Danilo Fliser; Hermann-Josef Gröne; Thimoteus Speer Journal: J Am Soc Nephrol Date: 2018-10-02 Impact factor: 10.121
Authors: Adeera Levin; Vlado Perkovic; David C Wheeler; Stefan Hantel; Jyothis T George; Maximilian von Eynatten; Audrey Koitka-Weber; Christoph Wanner Journal: Clin J Am Soc Nephrol Date: 2020-09-29 Impact factor: 8.237
Authors: Lihong Yang; Charlie Changli Xue; Wei Mao; Johannah Shergis; Lei Zhang; Anthony Lin Zhang; Xinfeng Guo; Xindong Qin; David Johnson; Xusheng Liu; Chuanjian Lu Journal: BMJ Open Date: 2019-05-01 Impact factor: 2.692