Chronic Kidney Disease May Be Common in Veterans Prior to Diabetes Diagnosis

Chronic kidney disease (CKD) may be common in veterans prior to a diabetes diagnosis in certain minority populations, and individuals in certain geographical locations may have a higher prevalence of CKD, according to a study published in PLos One.

Researchers conducted a retrospective observational study in 36,764 veterans at multiple Veterans Administration hospitals from 2002 to 2014 in an effort to assess the prevalence and extent to which CKD was diagnosed prior to and at initial diagnosis of diabetes.

Study results demonstrated a prevalence of CKD in 31.6% of veterans at the time of diabetes diagnosis, with 16% already demonstrating at least moderately reduced estimated glomerular filtration rates (eGFRs).

When results were standardized to the general population it was estimated that the occurrence of CKD was 241.8 cases per 1000 people (95% CI, 218.3-265.4) and after adjustment for age in men, was found to be 247.7 per 1000 people (95% CI, 230.2-265.2). 

After baseline adjustment for patient characteristics, the odds of a CKD diagnosis of any stage in veterans was found to increase with age, increased hemoglobin A1c, higher systolic blood pressure, and higher body mass index (BMI) (odds ratio [OR] 1.88; 95% CI, 1.82-1.93], [OR, 1.05; 95% CI, 1.04-1.06], [OR, 1.04; 95% CI, 1.027-1.043], [OR, 1.016; 95% CI, 1.011-1.020], respectively).

Further, veterans with an existing cerebrovascular disease, congestive heart failure, or peripheral artery disease had a higher risk for developing CKD ([OR, 1.23; 95% CI, 1.11-1.36]; OR, 1.87; 95% CI, 1.67-2.10], and [OR, 1.35; 95% CI: 1.21-1.51], respectively).  Finally, differences in the incidence of CKD diagnosis related to racial backgrounds were identified, with black (OR 1.11; 95% CI, 1.03-1.20) and Asian American (OR, 1.53; 95% CI, 1.15-2.04) veterans noted to have a higher adjusted odds of being diagnosed with CKD of any stage compared with white veterans.

This study assessed the odds of CKD based upon geographical regions in the United States and found higher incidences in the Midwest, South, and West (OR, 1.21; 95% CI, 1.01-1.31], [OR, 1.15; 95% CI, 1.07-1.24], and [OR, 1.09; 95% CI, 1.01-1.19], respectively), with the highest odds being in veterans in the Midwest (32.9%).  Overall, black veterans in the Midwest and South were found to have the highest prevalence rates. North Carolina had the highest values, with prevalence rates of 345.6 and 452.5 cases per 1000 white and black veterans, respectively (95% CI, 239.8-451.4 and 95% CI, 298.9-606.1, respectively).

Researchers concluded that approximately one-third of veterans diagnosed with diabetes had clinical evidence of CKD at the time of diabetes diagnosis, suggesting that either CKD precedes the diagnosis of diabetes and potentially causes CKD, or that due to CKD other comorbidities such as diabetes are more prevalent.  Clinicians should therefore consider evaluating individuals who present with CKD for diabetes as these conditions appear to be closely related.

Reference

Gatwood J, Chisholm-Burns M, Davis R, et al. Evidence of chronic kidney disease in veterans with incident diabetes mellitus. PLoS One. 2018;13:e0192712