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PLoS One. 2018 Feb 9;13(2):e0192712. doi: 10.1371/journal.pone.0192712. eCollection 2018.

Evidence of chronic kidney disease in veterans with incident diabetes mellitus.

Author information

1
University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN, United States of America.
2
University of Tennessee Health Science Center, Center for Biomedical Informatics, Memphis, TN, United States of America.
3
University of Tennessee Health Science Center, Department of Preventive Medicine, Memphis, TN, United States of America.
4
Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, United States of America.
5
Vanderbilt University School of Medicine, Nashville, TN, United States of America.
6
VA Tennessee Valley Healthcare System, Nashville, TN, United States of America.
7
Memphis VA Medical Center, Memphis, TN, United States of America.

Abstract

While chronic kidney disease (CKD) is regularly evaluated among patients with diabetes, kidney function may be significantly impaired before diabetes is diagnosed. Moreover, disparities in the severity of CKD in such a population are likely. This study evaluated the extent of CKD in a national cohort of 36,764 US veterans first diagnosed with diabetes between 2003 and 2013 and prior to initiating oral antidiabetic therapy. Evidence of CKD (any stage) at the time of diabetes diagnosis was determined using eGFR and urine-albumin-creatinine ratios, the odds of which were assessed using logistic regression controlling for patient characteristics. CKD was evident in 31.6% of veterans prior to being diagnosed with diabetes (age and gender standardized rates: 241.8 per 1,000 adults [overall] and 247.7 per 1,000 adult males), over half of whom had at least moderate kidney disease (stage 3 or higher). The odds of CKD tended to increase with age (OR: 1.88; 95% CI: 1.82-1.93), hemoglobin A1C (OR: 1.05; 95% CI: 1.04-1.06), systolic blood pressure (OR: 1.04; 95% CI: 1.027-1.043), and BMI (OR: 1.016; 95% CI: 1.011-1.020). Both Asian Americans (OR: 1.53; 95% CI: 1.15-2.04) and African Americans (OR: 1.11; 95% CI: 1.03-1.20) had higher adjusted odds of CKD compared to whites, and prevalence was highest in the Upper Midwest and parts of the Mid-South. Results suggest that evidence of CKD is common among veterans before a diabetes diagnosis, and certain populations throughout the country, such as minorities, may be afflicted at higher rates.

PMID:
29425235
PMCID:
PMC5806889
DOI:
10.1371/journal.pone.0192712
[Indexed for MEDLINE]
Free PMC Article

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