Kidney Week

Abstract: FR-PO330

Diabetes Mellitus Duration and Glycemic Control as Predictors of Diabetic Kidney Disease Progression: Evidence from 2019-2021 Korean National Health and Nutrition Examination Survey

Session Information

• Diabetic Kidney Disease: Clinical Modeling, Diagnosis, Education, and More
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Kim, Chang Seong, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Chang Seong Kim, MD, PhD

• Suh, Sang Heon, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Sang Heon Suh, MD, PhD

• Choi, Hong Sang, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Hong Sang Choi, MD, PhD

• Bae, Eun Hui, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Eun Hui Bae, MD, PhD

• Ma, Seong Kwon, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Seong Kwon Ma, MD, PhD

• Kim, Soo Wan, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Soo Wan Kim, MD, PhD

Background

The natural progression of diabetic kidney disease (DKD) is characterized by persistent proteinuria followed by a declining glomerular filtration rate (GFR). However, limited epidemiological data exist regarding the duration of diabetes mellitus (DM) and the severity of hyperglycemia with the progression of chronic kidney disease. We investigated the relationship between DM duration and glycemic control and DKD in South Korea by using data from the 2019-2021 Korea National Health and Nutrition Examination Surveys (KNHANES).

Methods

Among the 18,511 participants aged ≥20 years who completed the KNHANES, we analyzed 2,303 patients with DM in this study. DKD was defined as an estimated GFR (eGFR) below 60 ml/min per 1.73 m² or urinary albumin-to-creatinine ratio (UACR) of ≥30 mg/g. DM duration and severity were classified into six categories: new onset, <5, 5-10, 10-15, 15-20, and ≥20 years; and hemoglobin A1C (HbA1c) <6.5, 6.5-7, 7-8, 8-9, 9-10 and ≥10 %.

Results

The estimated prevalence of DKD among patients with DM aged ≥20 years was 26.7%. As DM duration and severity increased, UACR also increased gradually in a dose-dependently. The risk of DKD was significantly increased after 10 to 15 years of DM duration or with an HbA1c of 8 to 9% or higher compared to patients with newly diagnosed DM or those with HgA1c <6.5%. Albuminuria (UACR ≥30 mg/g) developed with a shorter duration of DM and at lower HbA1c levels than eGFR decline (<60 ml/min per 1.73 m²). In multivariable logistic regression models, compared with newly diagnosed patients and those with HgA1c <6.5%, the adjusted odds ratios for DKD were 3.77 (95% CI, 2.60–5.45) and 4.91 (95% CI, 2.80–8.63) in patients with DM duration ≥20 years and HbA1c ≥10%, respectively.

Conclusion

The overall prevalence of DKD among Korean adults is estimated to be three in ten patients with diabetes. Albuminuria was observed in early stages or in less severe hyperglycemic states. We should focus on surveilling kidney function in patients with a long duration of diabetes mellitus or uncontrolled hyperglycemia to prevent the progression of DKD.