Diabetic kidney disease in U.S. increased over last 20 years

Diabetic kidney disease (DKD) has become more prevalent in the United States over the last 2 decades due to the expansion of the diabetes population. In addition, the clinical pattern of DKD may be changing over time, with an increase in the impaired glomerular filtration rate (GFR), according to a study published in the June 22/29 issue of JAMA.

From 1988 to 2008, the prevalence of DKD in the U.S. population rose from 2.2% to 3.3%. At any given point in time, the number of people with DKD increased from 3.9 million during 1988-1994 to 5.5 million during 1999-2004 and then to 6.9 million during 2005-2008.

Among individuals with diabetes, the prevalence of DKD was steady, with 36.4% in 1988-1994, 34.5% in 1999-2004, and 34.5% in 2005-2008, despite increased use of glucose-lowering medications and renin-angiotensin-aldosterone system (RAAS) inhibitors, said Ian H. de Boer, MD, MS, lead author of the cross-sectional analyses of the Third National Health and Nutrition Examination Survey (NHANES III) in 1988-1994, NHANES 1999-2004, and NHANES 2005-2008.

“Among the diabetic population, use of glucose-lowering medications, RAAS inhibitors, and lipid-lowering medications increased markedly over the last 20 years, and intermediate therapeutic targets were substantially improved, but this did not translate to a decreased prevalence of DKD,” Dr. Boer wrote.

“Our results suggest that additional interventions are needed to prevent the development of diabetes and to target GFR loss once diabetes is diagnosed,” he added.

The authors noted that the current guideline recommendation to screen for GFR in addition to albuminuria should be followed, because of the increasingly frequent manifestation of impaired GFR.