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Trends in Diabetes, high cholesterol, and hypertension in Chronic Kidney Disease among US adults: 1988-1994 through 1999-2004

The National Heart, Lung and Blood Institute's Framingham Heart Study (CSF), Framingham, Massachusetts; Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Harvard Medical School, Boston MA (CSF) and Mt Sinai School of Medicine (PM), New York, NY

foxca{at}nhlbi.nih.gov

ABSTRACT

Objective: The prevalence of chronic kidney disease (CKD) increased among US adults from 1988-1994 through 1999-2004. We sought to explore the importance of trends in risk factors for CKD over time.

Research Design and Methods: The prevalence of cigarette smoking, obesity, hypertension, high cholesterol, and diabetes among US adults with stage-3 CKD (estimated GFR <60 ml/min/1.73m²) and albuminuria (urinary albumin to creatinine ratio 30 mg/g), separately, were determined for 1988-1994 and 1999-2004 using data from serial National Health and Nutrition Examination Surveys. The prevalence ratio (PR) for stage-3 CKD and albuminuria by the presence of these risk factors were compared across survey periods.

Results: The PR for CKD declined between 1988-1994 and 1999-2004 for obesity (PR=1.51 and 1.14 for 1988-1994 and 1999-2004, respectively; p-value for change=0.010), hypertension (PR=2.60 and 1.70; p-value for change=0.005) and high cholesterol (PR=1.58 and 1.20; p-value for change=0.028). However, for diagnosed diabetes, the prevalence ratio remained unchanged (1.64 in NHANES III and 1.62 in NHANES 1999-2004; p-value for change=0.898). Similar results were observed for undiagnosed diabetes: the prevalence ratio of CKD was 1.38 and 1.50 in NHANES III and NHANES 1999-2004; p=0.373). The association of cigarette smoking was similar in each time period. Besides obesity, for which the association remained stable over time, similar patterns were observed for the PR of albuminuria.

Conclusions: In terms of CKD, improvements in hypertension and high cholesterol management have been offset by both diagnosed and undiagnosed diabetes. Further increases in CKD may occur if diabetes continues to increase.

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