Five-Year Incidence of Chronic Kidney Disease (Stage 3-5) and Associated Risk Factors in a Spanish Cohort: The MADIABETES Study

Abstract

ObjectiveTo evaluate the incidence rate of Chronic Kidney Disease (CKD) stage 3-5 (persistent decreased kidney function under 60 mL/min per 1.73 m2) among patients with type 2 diabetes over five years, to identify the risk factors associated with CKD, and develop a risk table to predict five-year CKD stage 3-5 risk stratification for clinical use.DesignThe MADIABETES Study is a prospective cohort study of 3,443 outpatients with type 2 diabetes mellitus, sampled from 56 primary health care centers (131 general practitioners) in Madrid (Spain).ResultsThe cumulative incidence of CKD stage 3-5 at five-years was 10.23% (95% CI = 9.12–11.44) and the incidence density was 2.07 (95% CI = 1.83–2.33) cases per 1,000 patient-months or 2.48 (95% CI = 2.19–2.79) cases per 100 patient-years. The highest hazard ratio (HR) for developing CKD stage 3-5 was albuminuria ≥300 mg/g (HR = 4.57; 95% CI= 2.46-8.48). Furthermore, other variables with a high HR were age over 74 years (HR = 3.20; 95% CI = 2.13–4.81), a history of Hypertension (HR = 2.02; 95% CI = 1.42–2.89), Myocardial Infarction (HR= 1.72; 95% IC= 1.25–2.37), Dyslipidemia (HR = 1.68; 95% CI 1.30–2.17), duration of diabetes mellitus ≥ 10 years (HR = 1.46; 95% CI = 1.14-1.88) and Systolic Blood Pressure >149 mmHg (HR = 1.52; 95% CI = 1.02–2.24).ConclusionsAfter a five-year follow-up, the cumulative incidence of CKD is concordant with rates described in Spain and other countries. Albuminuria ≥ 300 mg/g and age over 74 years were the risk factors more strongly associated with developing CKD (Stage 3-5). Blood Pressure, lipid and albuminuria control could reduce CKD incidence of CKD in patients with T2DM.

Incidence of chronic kidney disease among people with diabetes: a systematic review of observational studies

“…Incident eGFR < 60 ml/min/1.73 m 2 was higher in those with poor glycaemic control , low baseline eGFR and with albuminuria , older age, longer duration of diabetes and macrovascular complications at baseline and high blood pressure .…”

“…b Annual cumulative incidence cannot be calculated because of duration of follow-up is not stated. diabetes and macrovascular complications at baseline [60,65] and high blood pressure [32,60,65].…”

Primacy of lowered baseline glomerular filtration rate as a risk for incident chronic kidney disease: A longitudinal study in Japanese subjects

“…Firstly, we found that seven variables such as lowered baseline eGFR, female gender, higher age, lower red cell and platelet count, and lower HDL‐c were significant risk factors for CKD in Japanese subjects. The risk factors per se were not particularly different from the previous studies . Of note, eGFR at the end of the observation was lower than 30 mL/min per m 2 in only one person and only a very small number of people developed proteinuria, so that this was largely a study on the development of “stage 3 CKD” …”

“…For effective intervention aiming at prevention, or retardation of the progression of CKD, knowing the risk factors for the disease and being able to identify subjects at risk are of paramount importance. Previously, higher age, uric acid (UA), triglycerides (TG) to HDL‐cholesterol (HDL‐c) ratio, lower HDL‐c and estimated glomerular filtration rate (eGFR), obesity, hypertension, anaemia, diabetes, metabolic syndrome (MetS) and female gender have been identified as risk factors . Risk models to predict CKD have been developed in Caucasian, European and Chinese people, and people from South Asia but longitudinal data in Japanese subjects are scarce .…”

Screening for chronic kidney disease in Belgrade primary health care centers

“…Although current guidelines recommend screening in individuals at risk for CKD [16], there are more data on the prevalence of CKD in the general population [17][18][19][20]. Nevertheless, a number of papers present the prevalence of CKD in patients with diabetes [21][22][23] but this is not the case with the prevalence of CKD in patients with hypertension. Although hypertension has been proven to be a risk factor for CKD and one of main causes of ESRD [24], the majority of studies present prevalence of ESRD caused by hypertension, but rarely the prevalence of early stages of CKD in patients with hypertension [25,26].…”