Age-related associations of hypertension and diabetes mellitus with chronic kidney disease.
BACKGROUND
Studies suggest end-stage renal disease incidence and all-cause mortality rates among patients with chronic kidney disease (CKD) differ by age. The association of diabetes mellitus and hypertension with CKD across the adult lifespan is not well established.


METHODS
Data from NHANES 1999-2004 were used to determine the association of risk factors for stage 3 or 4 CKD (n = 12,518) and albuminuria (n = 12,778) by age grouping (20 to 49, 50 to 69, and > or =70 years). Stage 3 or 4 CKD was defined as an estimated glomerular filtration rate of 15 to 59 ml/min/1.73 m2 and albuminuria as an albumin to creatinine ratio > or =30 mg/g.


RESULTS
For adults 20 to 49, 50 to 69 and > or =70 years of age, the prevalence ratios (95% confidence interval) of stage 3 or 4 CKD associated with hypertension were 1.94 (0.86 - 4.35), 1.51 (1.09 - 2.07), 1.31 (1.15 - 1.49), respectively (p-trend = 0.038). The analogous prevalence ratios (95% confidence interval) were 3.01 (1.35 - 6.74), 1.61 (1.15 - 2.25), 1.40 (1.15 - 1.69), respectively, for diagnosed diabetes mellitus (p-trend = 0.067); and 2.67 (0.53 - 13.4), 1.35 (0.69 - 2.63), 1.08 (0.78 - 1.51), respectively, for undiagnosed diabetes mellitus (p-trend = 0.369). The prevalence ratios of albuminuria associated with hypertension and diagnosed and undiagnosed diabetes mellitus were lower at older age (each p < 0.05).


CONCLUSIONS
Among US adults, diabetes mellitus and hypertension are associated with CKD and albuminuria regardless of age. However, the associations were stronger at younger ages.
Islam
Tareq M
TM
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Louisiana, USA. tislam@tulane.edu
Fox
Caroline S
CS
Mann
Devin
D
Muntner
Paul
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000419:Albuminuria / Q000453:epidemiology / Q000503:physiopathology; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D005919:Glomerular Filtration Rate / Q000502:physiology; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D014481:United States
D003404:Creatinine