The prevalence of CKD in adults with diagnosed diabetes increased from 20% in 1999–2004 to 25% in 2011–2014 (p=.001). Prevalence among adults with prediabetes (12% in 1999-2004 and 14% in 2011–2014) was similar to that among adults with undiagnosed diabetes (10% and 13%, respectively).
Chart Explanation: Over the periods 1999–2004 to 2011–2014, the prevalence of CKD varied based on diabetes status. Among U.S. adults with diagnosed diabetes, the prevalence significantly increased from 19.5% in 1999–2004 to 24.5% in 2011–2014 (p=.001). During the same period, CKD prevalence among those with pre-diabetes (12.4% to 14.3%), and among those with undiagnosed diabetes (10.1% to 13.2%) was relatively the same.
The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.
Diabetes-associated nephropathy is one of the two main causes of CKD. Diabetic nephropathy accounts for 30-40% of CKD and 44% of incident cases of end-stage renal disease (ESRD) in the United States (United States Renal Data System, 2017). Additionally, diabetes-related CKD is associated with high rates of morbidity and mortality (Foley et al., 2005; Go, Chertow, Fan, McCulloch, & Hsu, 2004). Thus, assessing the burden of this risk factor is essential to CKD surveillance. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center. Here we examined data from the 1999–2000, 2001–2002, 2003–2004, 2005–2006, 2007–2008, 2009–2010, 2011–2012, and 2013–014 NHANES. Self-reported diabetes was defined by answer of “yes” to the question “have you ever been told by a doctor or other health professional that you have diabetes or sugar diabetes?” Glycohemoglobin, which was approved as a diagnostic test for diabetes in 2010 (American Diabetes Association, 2010), was measured in all participants.
|Description of Measure||Prevalence of CKD in the diagnosed diabetes, undiagnosed diabetes, and prediabetes adult population|
|Type of Data Source||Public|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Noninstitutionalized U.S. residents aged 20+ years|
|Numerator||Nonpregnant participants with CKD|
|Denominator||Nonpregnant participants with completed surveys who report having diabetes (or HbA1c >6.4%)|
|Definition of CKD||Presence of single spot albuminuria or estimated glomerular filtration rate (eGFR) 15-59 ml/min/1.73m2|
|Glomerular filtration rate||Estimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]α x [max(calibrated serum creatinine in mg/dL/κ, 1)]κ x 0.993age x (1.018 if female) x (1.159 if non-Hispanic Black)|
κ = 0.7 if female, and 0.9 if male
α = -0.329 if female, and -0.411 if male
|Primary Data Source Indicator||diq010: "Other than during pregnancy, have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes?" yes/no|
|Primary Indicator Method of Measurement||Questionnaire (interviewer-administered); ages 1+ (proxy provided for ages 1–15); indicator sample covers ages 20+|
|Secondary (1)||lbxgh: Glycohemoglobin|
|Secondary (1) Indicator Method of Measurement||Examination/Laboratory|
|Secondary (2) Variable||rhd143, rhd141/rhd140, urxpreg: current pregnancy|
|Secondary (3) Variable||nhcode/rxddrgid: generic drug codes|
|Secondary (3) Indicator Method of Measurement||Questionnaire (interviewer-administered), with recording of medications from prescription bottles|
|Frequency of Measurement (Primary)||Once (cross-sectional)|
|U.S. Region Covered by Primary Variable||All|
|Period Currently Available||1999–2014|
|Additional Data Items of Interest||Stage of CKD, stratification variables of interest (age, gender, race/ethnicity, body mass index, hypertension by self-report)|
|Limitations of Indicator||Medication was not applied to analysis, which could potentially misclassify individuals|
|Analytic Considerations||Appropriate NHANES survey weights must be used for all analyses; glucose values must be converted for 2005-2006 and 2007-2008; if relative standard error 30% or more of estimate, must report as "low precision"|