CKD Common in People with Undiagnosed Diabetes

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Individuals with undiagnosed diabetes or prediabetes have a relatively high prevalence of CKD, according to a new study.

After adjusting for age, gender, and race/ethnicity, those with undiagnosed diabetes and prediabetes have a CKD prevalence of 24.2% and 17.1%, respectively, researchers reported in the Clinical Journal of the American Society of Nephrology (2010;5:673-682). Individuals with diagnosed diabetes and no diabetes have a CKD prevalence of 32.9% and 11.8%, respectively. Additionally, among subjects with CKD, 39.1% had undiagnosed or prediabetes.

Investigators led by Laura C. Plantinga, MD, of San Francisco General Hospital and University of California-San Francisco, analyzed National Health and Nutrition Examination Survey (NHANES) data from 1999 through 2006. NHANES is a representative survey of the civilian, noninstitutionalized U.S. population.

The study population included 8,188 subjects, of whom 826 had diagnosed diabetes, 299 had undiagnosed diabetes (fasting plasma glucose [FPG] of 126 mg/dL), 2,272 had prediabetes (FPG of 100 mg/dL or higher but less than 126 mg/dL), and 4,791 had no diabetes (FPG less than 100 mg/dL)., defined CKD as an estimated glomerular filtration rate of 15 to 59 mL/min/1.73 m2 or an albumin-creatinine ratio of 30 mg/g or higher.

In unadjusted analyses, the CKD prevalence was 39.6% and 41.7% for subjects with diagnosed and undiagnosed diabetes, respectively, and 17.7%, and 10.6% for those with prediabetes and no diabetes. “Age accounted for much of the difference between the unadjusted and adjusted CKD prevalence estimates,” the authors stated.

The undiagnosed and diagnosed groups had greater proportions of subjects aged 60 years or older than the prediabetes and no diabetes groups (45.6% and 44% vs. 31% and 14.4%, respectively), according to the investigators.

By applying their final CKD and diabetes prevalence estimates from the NHANES population to available U.S. Census data on noninstitutionalized adult civilian residents, the researchers estimate that up to 13 million U.S. adults may have undiagnosed or prediabetes and CKD.

“In keeping with our results, individuals with prediabetes warrant earlier detection and management efforts to prevent development, progression, and complications of both diabetes and CKD associated with diabetes,” the authors concluded.

They noted that current standards of diabetes care recommend annual CKD screening among those with diabetes, but this screening is unlikely to occur in those with undetected diabetes unless individuals have another risk factor that is being treated, such as hypertension. Their study showed that about 10% of people with undiagnosed diabetes “do not have a routine site for health care and are likely not being followed for any CKD risk factors.”

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