CoChat
Sign Up
Cited by 1,026Chronic Kidney Disease and DiabetesDiabetes Management and ResearchAcute Kidney Injury Research

Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014

Open access
Afkarian, Maryam, Zelnick, Leila R., Hall, Yoshio N., Heagerty, Patrick J., Tuttle, Katherine, Weiss, Noel S., de Boer, Ian H.·2016·JAMA
DOI 10.1001/jama.2016.10924PMC PMC5444809
Open this paper in CoChat — free accountOpen PDF

Abstract

IMPORTANCE: Diabetic kidney disease is the leading cause of chronic and end-stage kidney disease in the United States and worldwide. Changes in demographics and treatments may affect the prevalence and clinical manifestations of diabetic kidney disease. OBJECTIVE: To characterize the clinical manifestations of kidney disease among US adults with diabetes over time. DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional studies of adults aged 20 years or older with diabetes mellitus participating in National Health and Nutrition Examination Surveys from 1988 through 2014. EXPOSURES: Diabetes was defined as hemoglobin A1c greater than 6.5% or use of glucose-lowering medications. MAIN OUTCOMES AND MEASURES: Albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g), macroalbuminuria (urine albumin-to-creatinine ratio ≥300 mg/g), reduced estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2), and severely reduced eGFR (<30 mL/min/1.73 m2), incorporating data on biological variability to estimate the prevalence of persistent abnormalities. RESULTS: There were 6251 adults with diabetes included (1431 from 1988-1994, 1443 from 1999-2004, 1280 from 2005-2008, and 2097 from 2009-2014). The prevalence of any diabetic kidney disease, defined as persistent albuminuria, persistent reduced eGFR, or both, did not significantly change over time from 28.4% (95% CI, 23.8%-32.9%) in 1988-1994 to 26.2% (95% CI, 22.6%-29.9%) in 2009-2014 (prevalence ratio, 0.95 [95% CI, 0.86-1.06] adjusting for age, sex, and race/ethnicity; P = .39 for trend). However, the prevalence of albuminuria decreased progressively over time from 20.8% (95% CI, 16.3%-25.3%) in 1988-1994 to 15.9% (95% CI, 12.7%-19.0%) in 2009-2014 (adjusted prevalence ratio, 0.76 [95% CI, 0.65-0.89]; P < .001 for trend). In contrast, the prevalence of reduced eGFR increased from 9.2% (95% CI, 6.2%-12.2%) in 1988-1994 to 14.1% (95% CI, 11.3%-17.0%) in 2009-2014 (adjusted prevalence ratio, 1.61 [95% CI, 1.33-1.95] comparing 2009-2014 with 1988-1994; P < .001 for trend), with a similar pattern for severely reduced eGFR (adjusted prevalence ratio, 2.86 [95% CI, 1.38-5.91]; P = .004 for trend). Significant heterogeneity in the temporal trend for albuminuria was noted by age (P = .049 for interaction) and race/ethnicity (P = .007 for interaction), with a decreasing prevalence of albuminuria observed only among adults younger than 65 years and non-Hispanic whites, whereas the prevalence of reduced GFR increased without significant differences by age or race/ethnicity. In 2009-2014, approximately 8.2 million adults with diabetes (95% CI, 6.5-9.9 million adults) had albuminuria, reduced eGFR, or both. CONCLUSIONS AND RELEVANCE: Among US adults with diabetes from 1988 to 2014, the overall prevalence of diabetic kidney disease did not change significantly, whereas the prevalence of albuminuria declined and the prevalence of reduced eGFR increased.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jama.2016.10924

Cites

40 of 40 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • CKD 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 [2]

    The Clinical Manifestations of DKD section reports DKD in 26.2%–28.4% of US adults with diabetes across survey periods, within the claimed 20%–40% range. The claim is broader than this US study, and the limitations section says the underlying causes of kidney disease could not be determined; some cases were likely due to causes other than diabetes. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • 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 [2]

    The Introduction (page not provided) says reduced GFR without albuminuria has been frequently described, and Clinical Manifestations of DKD (page not provided) reports that reduced eGFR became more prevalent among US adults with diabetes. The reported trend is for reduced eGFR overall, not specifically reduced eGFR without albuminuria. The paper does not establish that this pattern increased in both type 1 and type 2 diabetes or that rising diabetes prevalence caused it. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • People with T2D and lower levels of albuminuria (ACR 30-299 mg/g) represent a larger proportion of people with T2D with increased CVD risk but at lower risk of CKD progression.

    “This recommendation also applies to people with T2D and lower levels of albuminuria (ACR 30 -299 mg/g [3 -29.9 mg/mmol]), which represent a larger proportion of people with T2D with increased CVD risk but at lower risk of CKDprogression.”

    From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [178]

    Table 2 (page not provided) shows that among US adults with diabetes, albuminuria at ACR ≥30 mg/g was more prevalent than macroalbuminuria at ACR ≥300 mg/g; this supports a larger group in the 30–299 mg/g range. The paper does not establish that comparison specifically for T2D, nor does it assess increased CVD risk or lower risk of CKD progression in that group. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • 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. (2,3,18,20,21).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [2]

    The introduction says reduced GFR without albuminuria has been frequently described, and the Clinical Manifestations of DKD section reports it in 8.9% of adults with diabetes in one survey period. The Results and Discussion report that reduced eGFR overall became more prevalent among US adults with diabetes, but do not establish a trend specifically for reduced eGFR without albuminuria or separately for type 1 and type 2 diabetes. The Discussion says the reasons for the increase in reduced eGFR cannot be conclusively determined, so it does not support attributing the trend to increasing diabetes prevalence. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • CKD 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)(2)(3)(4).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [2]

    The Clinical Manifestations of DKD section reports that 26.2%–28.4% of US adults with diabetes met the study’s criteria for diabetic kidney disease, within the claimed 20%–40% range. The limitations section says the underlying causes could not be determined and some kidney disease was likely due to causes other than diabetes. Thus the source supports the prevalence range for US adults, but not definitive attribution of every case to diabetes or an unqualified estimate for adults elsewhere. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [29]29. N Engl J Med. 2014;370(16):1514-1523.

Cited by

Sorted by citations

Related

Authors
Afkarian, M., Zelnick, L. R., Hall, Y. N., Heagerty, P. J., Tuttle, K., Weiss, N. S., & de Boer, I. H.
Affiliations
  • University of Washington (US)
  • Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle5Department of Epidemiology, University of Washington, Seattle
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2016-08-09
Volume
316
Issue
6
Pages
602
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2016.10924
PMC
PMC5444809
OpenAlex
W2512638651
Semantic Scholar
b153a5411fb5d41d85bbe844d3f9f859a70b27be
Cited by
1,026
References
40
Citations by year
2026: 81 · 2025: 119 · 2024: 119 · 2023: 109 · 2022: 134 · 2021: 133 · 2020: 130 · 2019: 80 · 2018: 80 · 2017: 33 · 2016: 8
FWCI
66.70
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • American Diabetes Association (R01DK088762)
  • Amgen
  • Eli Lilly and Company
  • Institute of Clinical and Translational Sciences
  • Ironwood Pharmaceuticals, Incorporated
  • Northwest Kidney Centers (R01DK088762)
  • American Kidney Fund
  • National Institutes of Health (UL1TR000423, UL1TR002319)
  • National Heart, Lung, and Blood Institute
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK104706, R01DK087726, R01DK099199, K23DK089017, R01DK088762)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords
diabetic nephropathy, albuminuria, macroalbuminuria, kidney disease prevalence, temporal trends, chronic kidney disease, end-stage renal disease, diabetes mellitus, NHANES, biological variation
MeSH terms
Adult, Aged, Albuminuria, Black or African American, Cross-Sectional Studies, Diabetes Mellitus, Diabetic Nephropathies, Female, Glomerular Filtration Rate, Glycated Hemoglobin, Hispanic or Latino, Humans, Hypoglycemic Agents, Kidney Failure, Chronic, Male, Mexico, Middle Aged, Nutrition Surveys, Time Factors, United States, Prevalence, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Black People, White People

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.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review