Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes

Abstract

Background and objectives: Prevalence of chronic kidney disease (CKD) in people with diagnosed diabetes is known to be high, but little is known about the prevalence of CKD in those with undiagnosed diabetes or prediabetes. We aimed to estimate and compare the community prevalence of CKD among people with diagnosed diabetes, undiagnosed diabetes, prediabetes, or no diabetes.

Design, setting, participants, & measurements: The 1999 through 2006 National Health and Nutrition Examination Survey is a representative survey of the civilian, noninstitutionalized US population. Participants who were aged > or =20 years; responded to the diabetes questionnaire; and had fasting plasma glucose (FPG), serum creatinine, and urinary albumin-creatinine ratio measurements were included (N = 8188). Diabetes status was defined as follows: Diagnosed diabetes, self-reported provider diagnosis (n = 826); undiagnosed diabetes, FPG > or =126 mg/dl without self-reported diagnosis (n = 299); prediabetes, FPG > or =100 and <126 mg/dl (n = 2272); and no diabetes, FPG <100 mg/dl (n = 4791). Prevalence of CKD was defined by estimated GFR 15 to 59 ml/min per 1.73 m(2) or albumin-creatinine ratio > or =30 mg/g; adjustment was performed with multivariable logistic regression.

Results: Fully 39.6% of people with diagnosed and 41.7% with undiagnosed diabetes had CKD; 17.7% with prediabetes and 10.6% without diabetes had CKD. Age-, gender-, and race/ethnicity-adjusted prevalence of CKD was 32.9, 24.2, 17.1, and 11.8%, for diagnosed, undiagnosed, pre-, and no diabetes, respectively. Among those with CKD, 39.1% had undiagnosed or prediabetes.

Conclusions: CKD prevalence is high among people with undiagnosed diabetes and prediabetes. These individuals might benefit from interventions aimed at preventing development and/or progression of both CKD and diabetes.

Figure 1.

Unadjusted (A) and age-, gender-, and race/ethnicity-adjusted (B) population prevalence (%) of stages 1 through 4 CKD, with estimation of GFR by the MDRD Study equation, by diabetes status, NHANES 1999 through 2006. Diagnosed diabetes is defined as self-report of provider diagnosis; undiagnosed diabetes is defined as FPG ≥126 mg/ml, without a report of provider diagnosis; prediabetes is defined as FPG ≥100 and <126 mg/dl; and no diabetes is defined as FPG <100 mg/ml. CKD is defined by MDRD Study equation–calculated eGFR stage and a single determination of albuminuria (stages 1 and 2). Values in parentheses (A) and bars (B) represent 95% confidence intervals.

Figure 2.

Unadjusted (A) and age-, gender-, and race/ethnicity-adjusted (B) population prevalence (%) of stages 1 through 4 CKD, with estimation of GFR by the CKD-EPI equation, by diabetes status, NHANES 1999 through 2006. Diagnosed diabetes is defined as self-report of provider diagnosis; undiagnosed diabetes is defined as FPG ≥126 mg/ml, without a report of provider diagnosis; prediabetes is defined as FPG ≥100 and <126 mg/dl; and no diabetes is defined as FPG <100 mg/ml. CKD is defined by CKD-EPI equation–calculated eGFR stage and a single determination of albuminuria (stages 1 and 2). Values in parentheses (A) and bars (B) represent 95% confidence intervals.