Diabetic Kidney Disease Rates Unchanged Over 30 Years

Prescribed diabetes therapies may be leading to reduced kidney function.

Surprising results from a new study revealed that the overall prevalence of diabetic kidney disease has remained consistent over the past 30 years, but the characteristics of kidney disease have changed markedly in the United States.

Published in JAMA, researchers found that the prevalence of any diabetic kidney disease dropped only slightly, from 28% between 1988 and 1994 to 26% between 2009 and 2014. However, the clinical manifestations of kidney disease appeared to change considerably.

Furthermore, albuminuria dropped from 21% (1988-1994) to 16% (2009-2014), while the reduced glomerular filtration rate (GFR) increased from 9% to 14% during the same time period. For the study, researchers analyzed data from 6251 adults with diabetes mellitus who participated in the National Health and Nutrition Examination Surveys from 1988 through 2014.

“We were wondering what’s happening with diabetic kidney disease in the last 30 years with advances in treatment,” said lead study author Ian de Boer.

The study authors said that the higher rate of prescribed diabetes therapies may be causing the decrease in the prevalence of albuminuria, indicating that the therapies are most likely working. However, worrisome findings from the study revealed an increase in reduced kidney function.

Authors noted that they are unable to conclusively explain this occurrence, but it may be possible that the treatments are contributing to a lower GFR or advances in treatments are helping diabetic patients live longer, and that a different type of kidney damage is occurring.

“This ties into what the NIH calls the precision medicine initiative, which is an initiative to look at genetics and biomarkers and other factors to understand what’s going on in individuals and to target therapies to individuals,” de Boer said. “In the kidney medicine space, how that is being applied is we would like to understand more than a person’s albuminuria status and GFR. We want to understand a person’s underlying biologic processes so we can target therapies to them.”

According to the US Centers for Disease Control and Prevention, 1 in 10 American adults (more than 20 million) have some degree of chronic kidney disease. Furthermore, study authors noted that diabetes in the leading cause of kidney disease in the United States, and is responsible for half of end-stage renal disease that requires dialysis.