GP Clinics


Kidney Damage Often Occurs Before Diabetes Diagnosis

Signs of chronic kidney disease (CKD) are common among adults prior to diabetes diagnosis, with the rates of CKD varying based on race, according to a recent study.
It is estimated that one-third of adults with diabetes mellitus also have CKD. In order to evaluate the extent to which CKD is found in patients prior to diabetes diagnosis and treatment, researchers conducted a study using data from a national cohort of 36,764 US veterans diagnosed with diabetes between 2003 and 2013.
Using eGFR and urine-albumin-creatinine ratios, the researchers determine whether evidence of CKD at any stage was present at time of diabetes diagnosis.
Overall, CKD was evident in 31.6% of the participants prior to diabetes diagnosis, with more than half having stage 3 or higher CKD. Odds of CKD increased with age (odds ratio [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).
Further, Asian Americans and African Americans had higher adjusted odds of CKD compared with white Americans, with the highest prevalence in the Upper Midwest and parts of the Mid-South.
“The current analysis suggests that expanded CKD and diabetes mellitus screening efforts may be necessary among veterans who are minorities, especially if cardiovascular comorbidities are present, in order to control the underlying kidney damage and narrow the disparities that exist in this population related to kidney disease, both independent of and in conjunction with diabetes mellitus, the researchers concluded.

Gatwood J, Chrisholm-Burns M, Davis R, et al. Evidence of chronic kidney disease in veterans with incident diabetes mellitus [published online February 9, 2018]. PLoS ONE.