糖尿病性腎症の有病率、
糖尿病有病率に比例して上昇、米国調査
| 文献：de Boer IH et al.Temporal Trends in the Prevalence of Diabetic Kidney Disease in the United States.JAMA. 2011;305(24):2532-2539 |
1988-2008年の米国国民健康栄養調査（NHANES）のデータに基づき、糖尿病性腎症の有病率を横断的分析で検討。調査期間中、糖尿病有病率の上昇に比例して、糖尿病性腎症の有病率も上昇した（2.2％から3.3％）。血糖降下薬などの治療薬処方率が上昇しているにもかかわらず、糖尿病患者の腎症有病率に変化は見られなかった。
Temporal Trends in the Prevalence of Diabetic Kidney Disease in the United States
1.. Ian H. de Boer, MD, MS;
2.. Tessa C. Rue, MS;
3.. Yoshio N. Hall, MD;
4.. Patrick J. Heagerty, PhD;
5.. Noel S. Weiss, MD, DrPH;
6.. Jonathan Himmelfarb, MD
[+] Author Affiliations
1.. Author Affiliations: Kidney Research Institute and Division of Nephrology (Drs de Boer, Hall, and Himmelfarb), Departments of Medicine (Drs de Boer, Hall, and Himmelfarb), Biostatistics (Ms Rue and Dr Heagerty), and Epidemiology (Drs de Boer and Weiss), University of Washington, Seattle.
Abstract
Context Diabetes is the leading cause of kidney disease in the developed world. Over time, the prevalence of diabetic kidney disease (DKD) may increase due to the expanding size of the diabetes population or decrease due to the implementation of diabetes therapies.
Objective To define temporal changes in DKD prevalence in the United States.
Design, Setting, and Participants Cross-sectional analyses of the Third National Health and Nutrition Examination Survey (NHANES III) from 1988-1994 (N = 15 073), NHANES 1999-2004 (N = 13 045), and NHANES 2005-2008 (N = 9588). Participants with diabetes were defined by levels of hemoglobin A1c of 6.5% or greater, use of glucose-lowering medications, or both (n = 1431 in NHANES III; n = 1443 in NHANES 1999-2004; n = 1280 in NHANES 2005-2008).
Main Outcome Measures Diabetic kidney disease was defined as diabetes with albuminuria (ratio of urine albumin to creatinine ?30 mg/g), impaired glomerular filtration rate (<60 mL/min/1.73 m2 estimated using the Chronic Kidney Disease Epidemiology Collaboration formula), or both. Prevalence of albuminuria was adjusted to estimate persistent albuminuria.
Results The prevalence of DKD in the US population was 2.2% (95% confidence interval [CI], 1.8%-2.6%) in NHANES III, 2.8% (95% CI, 2.4%-3.1%) in NHANES 1999-2004, and 3.3% (95% CI, 2.8%-3.7%) in NHANES 2005-2008 (P <.001 for trend). The prevalence of DKD increased in direct proportion to the prevalence of diabetes, without a change in the prevalence of DKD among those with diabetes. Among persons with diabetes, use of glucose-lowering medications increased from 56.2% (95% CI, 52.1%-60.4%) in NHANES III to 74.2% (95% CI, 70.4%-78.0%) in NHANES 2005-2008 (P <.001); use of renin-angiotensin-aldosterone system inhibitors increased from 11.2% (95% CI, 9.0%-13.4%) to 40.6% (95% CI, 37.2%-43.9%), respectively (P <.001); the prevalence of impaired glomerular filtration rate increased from 14.9% (95% CI, 12.1%-17.8%) to 17.7% (95% CI, 15.2%-20.2%), respectively (P = .03); and the prevalence of albuminuria decreased from 27.3% (95% CI, 22.0%-32.7%) to 23.7% (95% CI, 19.3%-28.0%), respectively, but this was not statistically significant (P = .07).
Conclusions Prevalence of DKD in the United States increased from 1988 to 2008 in proportion to the prevalence of diabetes. Among persons with diabetes, prevalence of DKD was stable despite increased use of glucose-lowering medications and renin-angiotensin-aldosterone system inhibitors.
KEYWORDS:
・DIABETES COMPLICATIONS,
・DIABETIC NEPHROPATHIES,
・GLOMERULAR FILTRATION RATE,
・KIDNEY DISEASES,
・TIME FACTORS,
・UNITED STATES.
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2011.06.24 記事提供：m3.com
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