Trends in Diabetes High Cholesterol and Hypertension in Chronic Kidney Disease Among U.S. Adults: 1988–1994 to 1999–2004

摘要

>OBJECTIVE—The prevalence of chronic kidney disease (CKD) increased among U.S. adults from 1988–1994 to 1999–2004. We sought to explore the importance of trends in risk factors for CKD over time>RESEARCH DESIGN AND METHODS—The prevalence of cigarette smoking, obesity, hypertension, high cholesterol, and diabetes among U.S. adults with stage 3 CKD (estimated glomerular filtration rate <60 ml/min per 1.73 m²) and albuminuria (urinary albumin-to-creatinine ratio ≥30 mg/g), separately, were determined for 1988–1994 and 1999–2004 using data from serial National Health and Nutrition Examination Surveys. The prevalence ratios (PRs) for stage 3 CKD and albuminuria by the presence of these risk factors were compared across survey periods.>RESULTS—The PR for CKD declined between 1988–1994 and 1999–2004 for obesity (PR 1.51 and 1.14 for 1988–1994 and 1999–2004, respectively; P for change = 0.010), hypertension (PR 2.60 and 1.70; P for change = 0.005), and high cholesterol (PR 1.58 and 1.20; P for change = 0.028). However, for diagnosed diabetes, the PR remained unchanged (1.64 and 1.62; P for change = 0.898). Similar results were observed for undiagnosed diabetes (PR of CKD 1.38 and 1.50; P for change = 0.373). The association of cigarette smoking was similar in each time period. Besides obesity, for which the association remained stable over time, similar patterns were observed for the PR of albuminuria.>CONCLUSIONS—In terms of CKD, improvements in hypertension and high cholesterol management have been offset by both diagnosed and undiagnosed diabetes. Further increases in CKD may occur if diabetes continues to increase.