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Observational Study
. 2018 Feb 9;13(2):e0192712.
doi: 10.1371/journal.pone.0192712. eCollection 2018.

Evidence of chronic kidney disease in veterans with incident diabetes mellitus

Justin Gatwood  1 , Marie Chisholm-Burns  1 , Robert Davis  2 , Fridtjof Thomas  3 , Praveen Potukuchi  4 , Adriana Hung  5   6 , Csaba P Kovesdy  4   7
Affiliations
Observational Study

Evidence of chronic kidney disease in veterans with incident diabetes mellitus

Justin Gatwood et al. PLoS One. .

Abstract

While chronic kidney disease (CKD) is regularly evaluated among patients with diabetes, kidney function may be significantly impaired before diabetes is diagnosed. Moreover, disparities in the severity of CKD in such a population are likely. This study evaluated the extent of CKD in a national cohort of 36,764 US veterans first diagnosed with diabetes between 2003 and 2013 and prior to initiating oral antidiabetic therapy. Evidence of CKD (any stage) at the time of diabetes diagnosis was determined using eGFR and urine-albumin-creatinine ratios, the odds of which were assessed using logistic regression controlling for patient characteristics. CKD was evident in 31.6% of veterans prior to being diagnosed with diabetes (age and gender standardized rates: 241.8 per 1,000 adults [overall] and 247.7 per 1,000 adult males), over half of whom had at least moderate kidney disease (stage 3 or higher). The odds of CKD tended to increase with age (OR: 1.88; 95% CI: 1.82-1.93), hemoglobin A1C (OR: 1.05; 95% CI: 1.04-1.06), systolic blood pressure (OR: 1.04; 95% CI: 1.027-1.043), and BMI (OR: 1.016; 95% CI: 1.011-1.020). Both Asian Americans (OR: 1.53; 95% CI: 1.15-2.04) and African Americans (OR: 1.11; 95% CI: 1.03-1.20) had higher adjusted odds of CKD compared to whites, and prevalence was highest in the Upper Midwest and parts of the Mid-South. Results suggest that evidence of CKD is common among veterans before a diabetes diagnosis, and certain populations throughout the country, such as minorities, may be afflicted at higher rates.

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Conflict of interest statement

Competing Interests: None of the authors declared significant relevant financial conflicts of interest. Drs. Hung and Kovesdy are employees of the US Department of Veterans Affairs. Opinions expressed in this paper are those of the authors and do not represent the official opinion of the US Department of Veterans Affairs This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Prevalence of CKD prior to DM diagnosis.
Fig 2
Fig 2. Odds of CKD prior to DM diagnosis.
*p<0.05 Total sample in regression = 30,792, Age in 10-year bands, Hb A1C in 0.5% increments, blood pressure in 5.0 increments, and BMI in 1.0 increments, BMI = body mass index; Hb A1C = Hemoglobin A1C; CVD = cerebrovascular disease; CHF = congestive heart failure; PAD = peripheral artery disease; MI = myocardial infarction; API = Asian Pacific Islander, Reference categories: White (Race), Non-Hispanic (Ethnicity), Northeast (Region).
Fig 3
Fig 3. Geographic distribution of CKD in patients with incident diabetes.
See this image and copyright information in PMC

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