Trends in diabetes, high cholesterol, and hypertension in chronic kidney disease among U.S. adults: 1988-1994 to 1999-2004

Abstract

Objective: The prevalence of chronic kidney disease (CKD) increased among U.S. adults from 1988-1994 to 1999-2004. We sought to explore the importance of trends in risk factors for CKD over time

Research design and methods: The prevalence of cigarette smoking, obesity, hypertension, high cholesterol, and diabetes among U.S. adults with stage 3 CKD (estimated glomerular filtration rate <60 ml/min per 1.73 m(2)) and albuminuria (urinary albumin-to-creatinine ratio >/=30 mg/g), separately, were determined for 1988-1994 and 1999-2004 using data from serial National Health and Nutrition Examination Surveys. The prevalence ratios (PRs) for stage 3 CKD and albuminuria by the presence of these risk factors were compared across survey periods.

Results: The PR for CKD declined between 1988-1994 and 1999-2004 for obesity (PR 1.51 and 1.14 for 1988-1994 and 1999-2004, respectively; P for change = 0.010), hypertension (PR 2.60 and 1.70; P for change = 0.005), and high cholesterol (PR 1.58 and 1.20; P for change = 0.028). However, for diagnosed diabetes, the PR remained unchanged (1.64 and 1.62; P for change = 0.898). Similar results were observed for undiagnosed diabetes (PR of CKD 1.38 and 1.50; P for change = 0.373). The association of cigarette smoking was similar in each time period. Besides obesity, for which the association remained stable over time, similar patterns were observed for the PR of albuminuria.

Conclusions: In terms of CKD, improvements in hypertension and high cholesterol management have been offset by both diagnosed and undiagnosed diabetes. Further increases in CKD may occur if diabetes continues to increase.

Figure 1—

PRs of CKD associated with selected risk factors in 1988–1994 (NHANES III) and in 1999–2004 (NHANES 1999–2004). Adjusted for age, race, sex, hypertension, and self-reported diabetes (except hypertension, which is adjusted for age, race, sex, and diabetes, and diabetes, which is adjusted for age, race, sex, and hypertension). P represents changes in the PRs over time.

Figure 2—

PRs of albuminuria associated with selected risk factors in 1988–1994 (NHANES III) and in 1999–2004 (NHANES 1999–2004). Adjusted for age, race, sex, hypertension, and self-reported diabetes (except hypertension, which is adjusted for age, race, sex, and diabetes, and diabetes, which is adjusted for age, race, sex, and hypertension). P represents changes in the PRs over time.