title: Clinical Manifestations of Kidney Disease Among US Adults With Diabetes, 1988-2014.
abstract: OBJECTIVE
  Diabetic kidney disease is the leading cause of chronic and end-stage kidney disease in the United States and worldwide. Changes in demographics and treatments may affect the prevalence and clinical manifestations of diabetic kidney disease.
  
  
  OBJECTIVE
  To characterize the clinical manifestations of kidney disease among US adults with diabetes over time.
  
  
  METHODS
  Serial cross-sectional studies of adults aged 20 years or older with diabetes mellitus participating in National Health and Nutrition Examination Surveys from 1988 through 2014.
  
  
  METHODS
  Diabetes was defined as hemoglobin A1c greater than 6.5% or use of glucose-lowering medications.
  
  
  METHODS
  Albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g), macroalbuminuria (urine albumin-to-creatinine ratio ≥300 mg/g), reduced estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2), and severely reduced eGFR (<30 mL/min/1.73 m2), incorporating data on biological variability to estimate the prevalence of persistent abnormalities.
  
  
  RESULTS
  There were 6251 adults with diabetes included (1431 from 1988-1994, 1443 from 1999-2004, 1280 from 2005-2008, and 2097 from 2009-2014). The prevalence of any diabetic kidney disease, defined as persistent albuminuria, persistent reduced eGFR, or both, did not significantly change over time from 28.4% (95% CI, 23.8%-32.9%) in 1988-1994 to 26.2% (95% CI, 22.6%-29.9%) in 2009-2014 (prevalence ratio, 0.95 [95% CI, 0.86-1.06] adjusting for age, sex, and race/ethnicity; P = .39 for trend). However, the prevalence of albuminuria decreased progressively over time from 20.8% (95% CI, 16.3%-25.3%) in 1988-1994 to 15.9% (95% CI, 12.7%-19.0%) in 2009-2014 (adjusted prevalence ratio, 0.76 [95% CI, 0.65-0.89]; P < .001 for trend). In contrast, the prevalence of reduced eGFR increased from 9.2% (95% CI, 6.2%-12.2%) in 1988-1994 to 14.1% (95% CI, 11.3%-17.0%) in 2009-2014 (adjusted prevalence ratio, 1.61 [95% CI, 1.33-1.95] comparing 2009-2014 with 1988-1994; P < .001 for trend), with a similar pattern for severely reduced eGFR (adjusted prevalence ratio, 2.86 [95% CI, 1.38-5.91]; P = .004 for trend). Significant heterogeneity in the temporal trend for albuminuria was noted by age (P = .049 for interaction) and race/ethnicity (P = .007 for interaction), with a decreasing prevalence of albuminuria observed only among adults younger than 65 years and non-Hispanic whites, whereas the prevalence of reduced GFR increased without significant differences by age or race/ethnicity. In 2009-2014, approximately 8.2 million adults with diabetes (95% CI, 6.5-9.9 million adults) had albuminuria, reduced eGFR, or both.
  
  
  CONCLUSIONS
  Among US adults with diabetes from 1988 to 2014, the overall prevalence of diabetic kidney disease did not change significantly, whereas the prevalence of albuminuria declined and the prevalence of reduced eGFR increased.
authors.affiliation: Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle.
authors.forename: Maryam
authors.initials: M
authors.lastname: Afkarian
authors.affiliation: Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle.
authors.forename: Leila R
authors.initials: LR
authors.lastname: Zelnick
authors.affiliation: Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle.
authors.forename: Yoshio N
authors.initials: YN
authors.lastname: Hall
authors.affiliation: Department of Biostatistics, University of Washington, Seattle.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.affiliation: Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle3Providence Health Care, Spokane, Washington4Institute of Translational Health Sciences, University of Washington School of Medicine, Seattle.
authors.forename: Katherine
authors.initials: K
authors.lastname: Tuttle
authors.affiliation: Department of Epidemiology, University of Washington, Seattle.
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
authors.affiliation: Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle5Department of Epidemiology, University of Washington, Seattle.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D044383:Black People / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
chemical_list: D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents