Trends in prevalence of chronic kidney disease and risk management among US adults with diabetes, 2001 to 2020.

AIMS: To examine trends in prevalence of chronic kidney disease (CKD) and risk management among US adults with diabetes between 2001 and 2020.

METHODS AND

RESULTS

This serial cross-sectional study included 4200 adults with diabetes (representing approximately 29.0 million persons) from the National Health and Nutrition Examination Survey (2001 to 2020). Age-adjusted prevalence of CKD G3a among adults with diabetes decreased from 6.6% to 3.0% by 2005-2008, then plateaued. CKD G4-G5 increased from 0.5% to 1.7% by 2009-2012, then decreased to 0.7% by 2017-2020. The prevalence of any CKD decreased from 34.1% to 25.3% by 2009-2012, then increased to 30.6% by 2017-2020. Correspondingly, albuminuria decreased from 28.4% to 21.2% by 2009-2012, then increased to 27.4% by 2017-2020. Among adults with concomitant CKD, proportion of adults achieving blood pressure (BP) < 140/90 mmHg increased from 64.6% to 75.1% by 2005-2008, then decreased to 59.5% by 2017-2020. Low-density lipoprotein cholesterol < 100 mg/dL, non-high-density lipoprotein cholesterol < 130 mg/dL, antidiabetic medication use and antihyperlipidemic medication use increased from 30.4%, 22.8%, 58.6%, and 33.8% to 46.4%, 45.6%, 74.2%, and 38.8%, respectively. Recommended antidiabetic medication use decreased from 37.6% to 24.2% by 2009-2012, then increased to 59.2% by 2017-2020.

CONCLUSIONS

After a decade of decline, the prevalence of any CKD and albuminuria increased among US adults with diabetes, while CKD G3a plateaued. CKD G4-G5 peaked during 2005-2012 and decreased thereafter. Lipid control and use of antidiabetic and antihyperlipidemic medications among adults with concomitant CKD increased in the past 2 decades, whereas BP control decreased. This study provided updated trends in the prevalence of chronic kidney disease (CKD) in diabetes and in risk factor control and medication use in diabetes and CKD by using a nationally representative sample of the whole US noninstitutionalized population. Among US adults with diabetes, the prevalence of CKD decreased in earlier years but increased in recent years, while improvements in medication use for diabetes and lipids were observed, though blood pressure control declined.