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.
| Field | Data |
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| Description of Measure | Prevalence of CKD in the diagnosed diabetes, undiagnosed diabetes, and prediabetes adult population |
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| Data Source | NCHS/CDC |
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| Type of Data Source | Public |
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| Data Set | NHANES |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic Group | Noninstitutionalized U.S. residents aged 20+ years |
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| Numerator | Nonpregnant participants with CKD |
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| Denominator | Nonpregnant participants with completed surveys who report having diabetes (or HbA1c >6.4%) |
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| Definition of CKD | Presence of single spot albuminuria or estimated glomerular filtration rate (eGFR) 15-59 ml/min/1.73m2 |
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| 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 |
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| 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 |
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| Primary Indicator Method of Measurement | Questionnaire (interviewer-administered); ages 1+ (proxy provided for ages 1–15); indicator sample covers ages 20+ |
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| Secondary (1) | lbxgh: Glycohemoglobin |
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| Secondary (1) Indicator Method of Measurement | Examination/Laboratory |
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| Secondary (2) Variable | rhd143, rhd141/rhd140, urxpreg: current pregnancy |
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| Secondary (3) Variable | nhcode/rxddrgid: generic drug codes |
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| Secondary (3) Indicator Method of Measurement | Questionnaire (interviewer-administered), with recording of medications from prescription bottles |
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| Frequency of Measurement (Primary) | Once (cross-sectional) |
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| U.S. Region Covered by Primary Variable | All |
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| Period Currently Available | 1999–2014 |
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| Pending Data | 2015–2016 |
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| Additional Data Items of Interest | Stage of CKD, stratification variables of interest (age, gender, race/ethnicity, body mass index, hypertension by self-report) |
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| Limitations of Indicator | Medication was not applied to analysis, which could potentially misclassify individuals |
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| 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" |
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