TY - JOUR
T1 - Evidence of chronic kidney disease in veterans with incident diabetes mellitus
AU - Gatwood, Justin
AU - Chisholm-Burns, Marie
AU - Davis, Robert
AU - Thomas, Fridtjof
AU - Potukuchi, Praveen
AU - Hung, Adriana
AU - Kovesdy, Csaba P.
N1 - Publisher Copyright:
© This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
PY - 2018/2
Y1 - 2018/2
N2 - 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.
AB - 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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U2 - 10.1371/journal.pone.0192712
DO - 10.1371/journal.pone.0192712
M3 - Article
C2 - 29425235
AN - SCOPUS:85041900588
SN - 1932-6203
VL - 13
JO - PloS one
JF - PloS one
IS - 2
M1 - e0192712
ER -