CKD Prevalence, Progression Rate High Among Elderly Diabetics

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In a South Korean study, nearly 60% of elderly patients with type 2 diabetes had chronic kidney disease at baseline.
In a South Korean study, nearly 60% of elderly patients with type 2 diabetes had chronic kidney disease at baseline.

South Korean investigators who studied a group of elderly patients with type 2 diabetes found that they have a high prevalence and progression rate of chronic kidney disease (CKD).

In a study of 190 patients aged 65 years or older (mean 70.4 years) who had type 2 diabetes for a mean duration of 10.6 years, the baseline prevalence of CKD—defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2 and/or the presence of albuminuria—was 59.5%, investigators from the CHA Bundang Medical Center in Seongnam led by Soo-Kyung Kim, MD, reported online in the Diabetes & Metabolism Journal.

The study population, which consisted of patients who visited a diabetes clinic at their institution, had a mean follow-up duration of 64.5 months. From baseline to the end of follow-up, the mean eGFR decreased significantly from 65.7 to 52.7 mL/min/1.73 m2. The annual rate of eGFR decline was 2.42 mL/min/1.73 m2.

Among patients with an eGFR of 60 mL/min/1.73 m2 or above, the progression rate to more than stage 3 CKD was 39.6% at the end of follow-up. In addition, 30.2% of progressed to albuminuria from normoalbuminuria, according to the researchers.

The authors found that diabetes duration of 10 years or more was associated with significant 3.46-fold increased odds of CKD at baseline compared with a duration of less than 5 years.

In an acknowledgement of study limitations, Dr Kim's team noted that their study sample was neither large nor representative of the Korean population. In addition, the Modification of Diet in Renal Disease (MDRD) study equation, which the investigators used to calculate eGFR, has not been validated in patients older than 70 years, and no coefficient of the MDRD equation has been published for Koreans. “This limitation might render CKD prevalence results imprecise.”

Reference

Kim KS, Park SW, Cho YW, Kim SK. Higher prevalence and progression rate of chronic kidney disease in elderly patients with type 2 diabetes mellitus.  Diabetes Metab J. 2018; published online ahead of print.

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