Head of PHARMO Research PHARMO Institute for Drug Outcomes Research Utrecht, Netherlands
Background: A substantial proportion of patients with chronic kidney disease (CKD) have type 2 diabetes (T2D) as well. Both co-existence of T2D on top of CKD and higher KDIGO (Kidney Disease: Improving Global Outcomes) risk categories increases the risk of cardiovascular and renal complications, and death. To assess the impact of this increased risk, the prevalence of KDIGO risk categories among CKD patients with and without T2D should be determined.
Objectives: To explore the impact of T2D on the distribution of KDIGO risk categories in patients with CKD in the Netherlands.
Methods: A cross-sectional design was used, with December 31, 2017 as the index date. Data for this study was obtained from the general practitioner (GP) and the hospital data of the PHARMO Data Network. The PHARMO GP data includes records from a population-based cohort derived from electronic medical records from participating Dutch general practitioners. The hospital data include admission data from the Dutch Hospital Data foundation of more than 80% of all Dutch hospitals. CKD was defined as a recorded CKD diagnosis and/or ≥2 estimated glomerular filtration rate (eGFR) measurements at least 90 days apart. For CKD stage 1 and 2 (i.e. eGFR measurements ≥60 mL/min/1.73 m2) an urine albumin-to-creatinine ratio (UACR) measurement ≥30 mg/g was required. T2D was defined as a recorded diagnosis of T2D or ≥1 prescription of blood glucose lowering drugs in the six months prior to the index date. Risk categories of CKD were defined according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) classification, based on (e)GFR and persistent albuminuria categories. Descriptive statistics were used for all analyses.
Results: At December 31, 2017, 112,050 patients were identified as having CKD. Almost 23% of patients with CKD also had a diagnosis of T2D. For one-third of patients without diabetes, the risk category of CKD could be determined. Among those, 70% had a moderate KDIGO risk, 20% a high risk and 10% a very high risk. Among CKD patients with T2D, the risk category of CKD could be determined for 50%. Among these, the percentages regarding moderate, high and very high risk were 64%, 23% and 13%, respectively.
Conclusions: Higher KDIGO risk categories seemed to be slightly more common in CKD patients with T2D than in CKD patients without diabetes. However, no KDIGO risk category could be determined for the majority of the patients with CKD, so no firm conclusions can be drawn.
