Consider ‘pre-CKD’ prevalence among pre-diabetics
Consider ‘pre-CKD’ prevalence among pre-diabeticsBisphosphonates not associated with femoral fractures, study suggests
About 13 million American adults have undiagnosed or pre-diabetes and chronic kidney disease (CKD), researchers concluded based on national survey data confirmed by lab tests.
Researchers analyzed a sample of 8,188 Americans from the National Health and Nutrition Examination Survey from 1996 to 2006, in a study funded by the Centers for Disease Control and Prevention and reported in the Clinical Journal of the American Society of Nephrology.
The unadjusted CKD prevalence was 39.6% and 41.7% in those with diagnosed and undiagnosed diabetes, respectively. In those with prediabetes, CKD was 17.7%, compared with 10.6% in non-diabetics.
Of those with diagnosed diabetes and CKD, 39% had stage 3 or 4 CKD, and for those with undiagnosed diabetes and CKD, 40.6% had stage 3 or 4 CKD. Among prediabetics, 56.2% had stage 3 or 4 CKD.
Among those with stage 3 or 4 CKD, evidence of albuminuria and reduced kidney function was present in 19.4%, 20.7%, 18.0%, and 14.5% of those with diagnosed diabetes, undiagnosed diabetes, prediabetes, and no diabetes, respectively. Stricter or looser definitions of CKD changed the prevalence, but not the patterns across diabetes categories.
The authors wrote, “A substantial proportion of adults with undiagnosed diabetes had evidence of kidney damage and/or kidney function decline. Current standards of diabetes care recommend annual CKD screening among those with diabetes; however, this screening is unlikely to occur in those with undetected diabetes.”
An accompanying editorial called for CKD screening to be extended to patients with prediabetes, and suggested that clinicians consider the concept of “pre-CKD,” identifying patients in the early stages of CKD when it's preventable or reversible.