Patients with type 2 diabetes (T2D) are at increased risk of chronic kidney disease (CKD) or end-stage renal disease (ESRD). We estimated the prevalence and incidence of CKD/ESRD among adults with incident T2D within a U.S. integrated healthcare system.
Incident T2D between 2003-2014 was identified based on a validated algorithm. CKD was defined as eGFR <60 ml/min/1.73m2 on ≥2 occasions 90 days apart and ESRD as initiation of chronic dialysis or renal transplant. Prevalence of CKD/ESRD was evaluated for the 2 years prior and 6 months after T2D diagnosis (index). Incidence of CKD/ESRD was evaluated from 6 months after index through 2018. Multivariable Cox proportional hazards models were used to study factors associated with CKD incidence.
We identified 135,199 incident T2D [mean age 58 years, 48% women, 36% White, 35% Hispanic, 12% Black, 13% Asian]. Median follow up was 6 years. Prevalence of CKD and ESRD was 12.3% and 0.2%, respectively. Median (IQR) eGFR closest to index was 86 (70-101) ml/min/1.73m2. The CKD/ESRD incidence rates decreased for recent diagnoses (2-year CKD incidence: 35.4 vs. 16.6 per 1000 person-years for those diagnosed in 2003-2004 vs. 2013-2014) (Table). Older age, white race, lower eGFR, higher A1c, and hypertension were associated with increased CKD incidence.
Though incidence rates are improving, a significant proportion of patients had reduced eGFR including CKD/ESRD at diagnosis.
J. An: Research Support; Self; Merck & Co., Inc., Novartis AG. G.A. Nichols: Research Support; Self; Boehringer Ingelheim International GmbH, Bristol-Myers Squibb, Merck & Co., Inc. L. Qian: None. Z. Li: None. M.A. Munis: None. R. Wei: None. T. Harrison: None. T. Weiss: Employee; Self; Merck & Co., Inc. S. Rajpathak: Employee; Self; Menarini Group. K. Reynolds: Research Support; Self; CSL Behring, Merck & Co., Inc., National Institutes of Health, Novartis Pharmaceuticals Corporation.