Chronic kidney disease (CKD) burden in the United States is surpassing other types of noninfectious diseases, pointing to a need to address metabolic and dietary factors such as diabetes that are leading to higher CKD-related deaths, particularly in younger people, according to a study published in JAMA Network Open.
For the clinical laboratory community, this means that glucose levels should be recognized and investigated, the study’s lead senior author Ziyad Al-Aly, MD, director of VA Saint Louis Health Care System’s Clinical Epidemiology Center, told CLN Stat. “If diabetes is diagnosed or confirmed, the disease should be treated early to prevent the development of untoward long-term consequences,” he said.
Much has happened since 2002 when the National Kidney Foundation first issued guidelines for defining and classifying CKD. Changes have taken place in population growth, aging, and in the epidemiology of risk factors such as diabetes, which has soared in prevalence since the turn of the century. “We wanted to do a study to evaluate the change in the burden of CKD over the past 15 years, how did it change, and what is driving this change,” Al-Aly said.
Looking at data from 2002 to 2016, Al-Aly and his colleagues found that disability-adjusted life years (DALYs) due to CKD increased by greater than 52%, from approximately 1.2 million to 1.9 million. The investigators linked the rise in CKD DALYs to three major factors: increased risk exposure (40.3%), aging (32.3%), and population growth (27.4%).
Additionally, Al-Aly and his colleagues pointed to increased exposure to dietary factors (diets high in sodium and sugar) and metabolic risk factors (high body-mass index, and elevated fasting plasma glucose and systolic blood pressure levels) as contributors to the increase in CKD burden, including CKD-related mortality.
Both actual deaths due to CKD and the probability of dying from CKD increased over the study period. Deaths mounted by nearly 60%, from 52,127 in 2002 to 82,539 in 2016. Likewise, the probability of dying from CKD grew by 26%, with much of this increased risk attributable to diabetes.
CKD burden was especially high in the South. Mississippi yielded the highest rate of age-standardized CKD-related DALYs per 100,000 persons(697), followed by Louisiana (681), Alabama (604), West Virginia (587), Georgia (560), Arkansas (553), South Carolina (550), Kentucky (550), Indiana (515), and North Carolina (515). “These states generally have a greater number of people with risk factors for kidney disease including hypertension, obesity, and diabetes, and these manifest in higher burden of CKD,” said Al-Aly.
States with the lowest rate of CKD-related DALYs included Vermont (321), Washington (328), Colorado (331), Montana (333), Oregon (342), Wyoming (343), New Hampshire (343), Iowa (349), Rhode Island (355), and Connecticut (356). Mississippi had twice the CKD-related DALY rate as Vermont.
Addressing dietary and metabolic risk exposure in young adults is a key measure in reducing CKD burden, the investigators concluded.
“Earlier in life, CKD portends serious consequences, which manifest in a higher probability of death among the segment of the population that contributes considerably to economic prosperity, representing significant loss of human capital,” they wrote, suggesting efforts to devote local, state, and federal resources to mitigate CKD development and pay closer attention to CKD’s effects in younger adults.