Diabetes and Kidney disease

[Guest guest]

THis is especially relevant to Bandsters, many of whom have type 1 or type 2

diabetes. The standard kidney function test done by non-specialists do NOT

reveal subtle kidney disease. The standard tests only reveal kidney disease when

there is only about 10% kidney function left.

IMO, everyone with diabetes needs specialized kidney tests to see if their

kidneys re functioning well - espeically before they start any high-protein

pre-op diets.

This info is passed on by a good friend, a kidney specialist, who sees many

people referred FOR THE FIRST TIME when they are almost at the point of needing

dialysis.

Sandy r

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Millions in United States May Have Undetected Chronic Kidney Disease

Fowler Larson

March 25, 2010 — As many as 13 million Americans may have undiagnosed diabetes

or prediabetes and undetected chronic kidney disease (CKD), according to a study

published in the April issue of the Clinical Journal of the American Society of

Nephrology.

Available figures show that more than 40% of adults diagnosed with diabetes also

have CKD, demonstrated by either albuminuria (excessive urine protein) or

impaired kidney function. Diabetes affects 13% of adults, 25% of whom are

undiagnosed. Thirty percent of adults have prediabetes, also called borderline

diabetes.

" Despite the heavy burden of undiagnosed diabetes and prediabetes, relatively

little is known about CKD prevalence in affected individuals, " write

Plantinga, ScM, from the Department of Medicine, San Francisco General Hospital,

and the University of California–San Francisco, and colleagues.

The study goal was to approximate the incidence of CKD in those with undiagnosed

diabetes and prediabetes compared with others who have diagnosed diabetes or are

free of the disease. Investigators used data from the 1999 through 2006 National

Health and Nutrition Examination Survey to study nearly 8200 individuals. They

evaluated factors including the demographics, socioeconomic status, and clinical

indicators of the participants.

A " yes " answer to the question, " Have you ever been told by a doctor or other

health professional that you have diabetes or sugar diabetes? " was the criteria

for confirming a diagnosis. Subjects who answered " no " or " borderline " were

sorted only by their fasting plasma glucose (FPG) measurement. FPG equal to or

greater than 126 mg/dL was classified as undiagnosed diabetes, and FPG equal to

or greater than 100 but less than 126 mg/dL was labeled as prediabetes. FPG of

less than 100 mg/dL constituted no diabetes.

Because impaired kidney function can be present without albuminuria in those

with type 2 diabetes, the researchers characterized CKD as the presence of

reduced kidney function or albuminuria. An estimated glomerular filtration rate

of 15 to 59 mL/minute/1.73 m2 or an albumin-creatinine ratio of more than 30

mg/g was used to designate CKD. Multivariable logistic regression was used to

perform adjustments.

Findings Could Lead to New Diagnosis

The results showed nearly the same rate of CKD among those with diagnosed and

undiagnosed diabetes, as follows:

39.6% with diagnosed diabetes had CKD, as did 41.7% with undiagnosed diabetes

17.7% with prediabetes and 10.6% without diabetes had CKD

39.1% of participants with CKD had undiagnosed or prediabetes

" Based on these results, there may be a substantial number of individuals in the

United States — up to 13 million — who have undiagnosed diabetes or prediabetes

and who already have signs of kidney damage and/or reduced kidney function, " Ms.

Plantinga said in a news release. As explained in the news release, " Such

patients would be at high risk for worsening kidney disease and diabetes, and

for the poor outcomes associated with both conditions — including cardiovascular

disease and death. "

The prevalence of CKD after adjusting for age, sex, and race/ethnicity was

32.9%, 24.2%, 17.1%, and 11.8% for diagnosed, undiagnosed, prediabetes, and no

diabetes, respectively. Subjects with undiagnosed diabetes were more often men

than those with diagnosed diabetes (P = .005). Participants with prediabetes

were more likely to be men than those with no diabetes (P < .001). Of those with

undiagnosed diabetes, prediabetes, or no diabetes, most were non-Hispanic whites

(P = .015, P < .001, and P < .001, respectively).

An editorial by Curhan, MD, ScD, from the Channing Laboratory and Renal

Division, Department of Medicine, Brigham and Women's Hospital, Boston,

Massachusetts, published with the study, proposes a new diagnosis: pre-CKD. " The

importance of prevention cannot be overstated, " he said.

Dr. Curhan recommended that future studies establish a protocol for serial

albuminuria and creatinine measurements for long-term tracking of alterations in

albuminuria and kidney function. He added that it is critical to find out

whether screenings should include those for serum phosphate and left ventricular

hypertrophy — factors related to CKD.

" These data could lead to the development of risk scores, which would be

particularly helpful in the clinical setting, " Dr. Curhan said. " To make a

substantial impact on this growing problem, we as a community need to focus on

helping individuals avoid these preventable conditions. "

The Centers for Disease Control and Prevention, in cooperation with the

Association of American Medical Colleges, supported the study. The study authors

have disclosed no relevant financial relationships.

Clin J Am Soc Nephrol. 2010;5:557-559, 673-682.