Kidney disease accounts for most of the increased risk of dying early among diabetics

Preventing and treating kidney disease in those with diabetes could save lives

2013-01-25

(Press-News.org) Highlights Among people without diabetes or kidney disease, 10-year mortality was 7.7%. Among individuals with diabetes but without kidney disease, mortality was 11.5%. Among those with both diabetes and kidney disease, mortality was 31.1%.

26 million people in the US and 340 million people in the world have type 2 diabetes.

Washington, DC (January 24, 2013) — One in every 10 Americans has diabetes, and a third or more of those with the condition will develop kidney disease. It may be possible to live a long and healthy life with diabetes, but once kidney disease develops, the risk of dying prematurely increases significantly, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings have significant clinical implications for the prevention and treatment of kidney disease in people with diabetes.

Because people with diabetes have an increased likelihood of dying prematurely as well as an increased likelihood of developing kidney disease, Maryam Afkarian, MD, PhD (University of Washington) and her colleagues looked to see how the former affects the latter. In other words, how much does kidney disease contribute to diabetics' increased risk of dying early?

The researchers examined 10-year mortality rates in 15,046 US adults. Kidney disease was present in 9.4% and 42.3% of individuals without and with type 2 diabetes, respectively.

Among the major findings: Among people without diabetes or kidney disease, 10-year mortality was 7.7%. Among individuals with diabetes but without kidney disease, mortality was 11.5%. Among individuals with both diabetes and kidney disease, mortality was 31.1%.

"People with type 2 diabetes have many other risk factors for cardiovascular disease and mortality, so we expected that kidney disease would predict a part, but not a majority, of higher mortality associated with type 2 diabetes. To our surprise, we found that even in the medically complex patients with type 2 diabetes, kidney disease is a very powerful predictor of premature death," said Dr. Afkarian.

She noted that the findings have important implications. "First, among people with type 2 diabetes, the subgroup with kidney disease carries most of the mortality risk, so targeting intensive risk factor modification on this subgroup is likely to have the highest impact on overall mortality of people with diabetes. Secondly, preventing kidney disease may be a powerful way of reducing mortality in people with diabetes," said Dr. Afkarian.

### Study co-authors include Michael Sachs, PhD, Bryan Kestenbaum, MD, MS, Irl Hirsch, MD, Katherine Tuttle, MD, FACP, FASN, Jonathan Himmelfarb, MD, and Ian de Boer, MD, MS (University of Washington).

Disclosures: The authors reported no financial disclosures.

The article, entitled "Kidney Disease Identifies Increased Mortality Risk in Type 2 Diabetes," will appear online at http://jasn.asnjournals.org/ on January 24, 2013, doi: 10.1681/2012070718.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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