Increasing Mortality in Adults With Diabetes and Low Estimated Glomerular Filtration Rate in the Absence of Albuminuria Journal Article

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Authors: Kramer, H; Boucher, R. E.; Leehey, D.; Fried, L.; Wei, G.; Greene, T.; Rosas, S. E.; Cooper, R; Cao, G; Beddhu, S.
Article Title: Increasing Mortality in Adults With Diabetes and Low Estimated Glomerular Filtration Rate in the Absence of Albuminuria
Abstract: OBJECTIVE: Improved blood pressure control and use of renin-angiotensin-aldosterone system blockers have altered the clinical presentation or phenotype of chronic kidney disease (CKD) in U.S. adults with diabetes. These changes may influence mortality. RESEARCH DESIGN AND METHODS: Data from the National Health and Nutrition Examination Surveys (NHANES) 1988-2006 were used to examine mortality trends in adults with diabetes, defined as physician diagnosis, fasting glucose gt;/=126 mg/dL, HbA1c gt;6.5% (48 mmol/mol), or use of glucose-lowering medications. Mortality trends by CKD phenotype (estimated glomerular filtration rate [eGFR] and urine albumin-to-creatinine ratio [ACR] level) were obtained via linkage with the National Death Index through 31 December 2011 while accounting for the complex survey design. RESULTS: From 1988 to 2006, adults with an eGFR /=30 mg/g but increased in those with eGFR lt;60 mL/min/1.73 m(2) and an ACR lt;30 mg/g from 35 deaths per 1,000 person-years (95% CI 22, 55) during years 1988-1994 to 51 deaths per 1,000 person-years (95% CI 33, 83) during years 2003-2006. CONCLUSIONS: ACR values are decreasing in U.S. adults with diabetes, but optimal management strategies are needed to reduce mortality in those with a low eGFR and an ACR lt;30 mg/g.
Journal Title: Diabetes care
Volume: 41
Issue: 4
ISSN: 1935-5548; 0149-5992
Publisher: by the American Diabetes Association  
Journal Place: United States
Date Published: 2018
Start Page: 775
End Page: 781
Language: eng
DOI/URL:

10.2337/dc17-1954
Notes: LR: 20180401; CI: (c) 2018; GR: C06 RR011234/RR/NCRR NIH HHS/United States; GR: R01 DK091437/DK/NIDDK NIH HHS/United States; GR: R21 DK106574/DK/NIDDK NIH HHS/United States; GR: UL1 RR025764/RR/NCRR NIH HHS/United States; JID: 7805975; PMCR: 2019/04/01 00:00; 2017/09/19 00:00 [received]; 2018/01/06 00:00 [accepted]; 2019/04/01 00:00 [pmc-release]; 2018/02/14 06:00 [pubmed]; 2018/02/14 06:00 [medline]; 2018/02/14 06:00 [entrez]; ppublish