L SUKKAR1,2, A KANG1, M JUN1, C FOOTE1,3, R PECOITIS-FILHO4, B NEUEN1, A SCARIA1, J BAKER1, K ROGERS1, A CASS5, C POLLOCK6, D SULLIVAN7, G WONG8, J KNIGHT1, D PEIRIS1, M GALLAGHER1, M JARDINE1
1The George Institute For Global Health, , Australia, 2Sydney School of Public Health, The University of Sydney, , Australia, 3Concord Repatriation General Hospital, , Australia, 4Pontificia Universidade Catolica do Parana, , Brazil, 5Menzies School of Health Research, , Australia, 6Kolling Institute for Medical Research, , Australia, 7NHMRC Clinical Trials Centre, The University of Sydney, , Australia, 8Centre for Kidney Research, The University of Sydney, , Australia
Aim: To estimate incidence, prevalence and associations of Chronic Kidney Disease (CKD) in diabetes.
Background: The incidence of CKD is estimated as 0.4 per 100 person-years in adults overall but appears higher with age and diabetes.
Methods:Based on data from the EXTEND45 study (the 45 and Up Study linked to hospital and community pathology datasets by the Centre for Health Record Linkage[CHeReL] and the Medicare Benefits Schedule[MBS] and Pharmaceutical Benefits Scheme[PBS] datasets provided by the Department of Human Services), we identified a population-based cohort(2006-2014) of 24,400 people aged ≥45 years with diabetes. We used Poisson regression to estimate CKD(eGFR<60 ml/min/1.73m2) incidence and prevalence. Multivariable Cox regression was used to examine associations between baseline sociodemographic factors, comorbidities and incident CKD.
Results:Of 24,400 participants with diabetes, 2,789(11.4%) had prevalent CKD and 1,771(7.2%) developed incident CKD over a mean follow-up of 4.3 years. CKD incidence rate was 4.93 (95% confidence interval [CI]: 4.70-5.16) per 100 person-years. Compared to those who had no CKD, those with CKD were older (mean age: 64.7, 75.2, 70.2 years, for no CKD, prevalent CKD, incident CKD respectively), had a lower proportion of current smokers (7.9%, 3.1% 4.7% respectively) and a lower proportion with an annual household income of >$70,000 (17.1%, 6.2%, 10.5%). Incident CKD was predicted by age (hazard ratio [HR]: 1.07[1.07-1.08] per year increase), geography (Outer regional vs major city: 1.41[1.17-1.69]), BMI (obese vs normal: 1.43[1.23-1.68]), presence of hypertension (1.48[1.27-1.73]), coronary heart disease (1.24[1.11-1.40]) and depression (1.26[1.09-1.45]).
Conclusions: In a contemporary cohort of Australians with diabetes, the incidence of CKD is high and independently predicted by age as well as geography, obesity, a baseline history of cardiovascular disease and depression.
Dr Louisa Sukkar is a PhD candidate at The George Institute for Global Health and a practicing nephrologist. Her research interests lie in the epidemiology of chronic kidney disease and diabetes with a specific focus on cardiovascular disease and health service use in these high risk populations.