Decreasing Prevalence of Chronic Kidney Disease Among U.S. Adults With Diabetes, 1999–2018

Introduction The prevalence of chronic kidney disease among persons with diabetes in the U.S. appears to be decreasing. Understanding the reasons for this decrease is an important health policy issue. Methods Data on 7,320 adults with diabetes from National Health and Nutrition Examination Survey (1999–2018) were examined to estimate the prevalence of chronic kidney disease in 4-year cohorts. Chronic kidney disease was defined by an estimated glomerular filtration rate '60 ml/min/1.73m² or urine albumin-to-creatinine ratio ≥30 mg/g. Diabetes and hypertension were defined by combination of self-report, medication, or laboratory detection. Weighted logistic regression models adjusting for demographics, comorbidities, angiotensin-converting enzyme inhibitor/angiotensin-2 receptor blocker medication, smoking, diet, and physical activity were used to assess change in chronic kidney disease prevalence over time. Results The prevalence of chronic kidney disease among individuals with diabetes decreased from 40.5% to 35.4% over 20 years (p =0.02) with a decline of ∼5% during each 4-year period (OR=0.95, 95% CI=0.90, 0.99) and ∼7% per 4-year period (OR=0.93, 95% CI=0.88, 0.98) for albuminuria. The reduction in chronic kidney disease prevalence was greater after adjusting for demographics (OR=0.92, 95% CI=0.88, 0.97). After adjusting for glucose; blood pressure; medication use; and health behaviors, including smoking, diet, and physical activity, the decreasing trend became nonstatistically significant (OR=0.95, 95% CI=0.90, 1.00), suggesting that these factors may have played a role in the lower chronic kidney disease prevalence over time. No decrease in chronic kidney disease was seen among individuals with hypertension. Conclusions The prevalence of chronic kidney disease among participants with diabetes has decreased steadily in the U.S. over the past 20 years, mostly from reductions in the prevalence of albuminuria. Improvements in medical management may explain part of the decrease. Individuals adopting healthy lifestyle behaviors may further explain the decrease.