Temporal trends in the prevalence of diabetic kidney disease in the United States
Open accessAbstract
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 A(1c) 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 m(2) 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.
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Reduced eGFR without albuminuria has been frequently reported in type 1 and type 2 diabetes and is becoming more common over time as the prevalence of diabetes increases in the U.S.
“Reduced eGFR without albuminuria has been frequently reported in type 1 and type 2 diabetes and is becoming more common over time as the prevalence of diabetes increases in the U.S. (2,3,16,(19)(20)(21).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [3]
The Comment section reports that impaired GFR can occur without substantial albuminuria and describes it as increasingly frequent relative to albuminuria. The Results show an increase in impaired GFR with or without albuminuria, while the Comment says overall diabetic kidney disease prevalence rose in proportion to diabetes prevalence. The paper does not establish a separate temporal trend for reduced eGFR specifically without albuminuria, or that such a trend occurred in both type 1 and type 2 diabetes. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCKD attributed to diabetes in adults occurs in 20-40% of people with diabetes.
“In this section, the focus is on CKD attributed to diabetes in adults, which occurs in 20-40% of people with diabetes (1-4).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [3]
In two trials, adding niacin produced small improvements in lipids but no significant reduction in ASCVD events.
“In each of these trials, the addition of niacin resulted in small improvements in lipids, but these changes were not accompanied by any significant reduction in ASCVD events.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [383]
The Results section reports trends in diabetic kidney disease, and the Comment section discusses glucose control and kidney outcomes. Searches for niacin, lipid improvements, and ASCVD events found no passage addressing the claimed two trials. (LLM, conf=0.76)
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The clustering of Cardiovascular, Renal, Adipo-Metabolic Eye and Liver disease with type 2 diabetes
Thomas, M. C. (2022) · Metabolism · doi:10.1016/j.metabol.2021.154961 · Cited by 41 · see citing works
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- Authors
- de Boer, I. H.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2011-06-22
- Volume
- 305
- Issue
- 24
- Pages
- 2532
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3731378
- OpenAlex
- W1997042641
- Cited by
- 1,036
- References
- 48
- Citations by year
- 2026: 29 · 2025: 72 · 2024: 75 · 2023: 74 · 2022: 57 · 2021: 89 · 2020: 101 · 2019: 79 · 2018: 68 · 2017: 72 · 2016: 66 · 2015: 78 · 2014: 69 · 2013: 57 · 2012: 41
- FWCI
- 43.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eli Lilly and Company
- University of Washington (UL1 RR025014, 5KL2RR025015)
- Satellite Healthcare
- National Institutes of Health (5kl2rr025015-02)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK087726, K23DK087900, R01DK088762)
- National Center for Research Resources (KL2-RR025015, UL1RR025014, 5KL2RR025015)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetic nephropathy, prevalence trends, albuminuria, diabetes prevalence, glucose-lowering medications, diabetes treatment, chronic kidney disease, NHANES, temporal trends, United States population, HbA1c, estimated glomerular filtration rate, health disparities, racial and ethnic disparities
- MeSH terms
- Adult, Aged, Albuminuria, Cross-Sectional Studies, Diabetes Mellitus, Diabetic Nephropathies, Female, Glomerular Filtration Rate, Humans, Hypoglycemic Agents, Male, Middle Aged, Nutrition Surveys, Renin-Angiotensin System, Time Factors, United States, Prevalence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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