Estimation of chronic kidney disease incidence from prevalence and mortality data in American Indians with type 2 diabetesReport as inadecuate

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The objective was to estimate chronic kidney disease CKD incidence rates from prevalence and mortality data, and compare the estimates with observed true incidence rates in a well-characterized population with diabetes. Pima Indians aged 20 years and older with type 2 diabetes were followed from 1982 through 2007. CKD was defined by estimated GFR eGFR <60 ml-min-1.72 m2 or albumin-to-creatinine ratio ACR ≥30 mg-g. True CKD incidence and mortality rates were computed for the whole study period, and prevalence for the intervals 1982–1994 and 1995–2007. Estimated age-sex stratified CKD incidence rates were computed using illness-death models of the observed prevalences, and of the whole-period mortality rate ratio of CKD to non-CKD persons. Among 1201 participants, 616 incident events of CKD occurred during a median follow-up of 5.6 years. Observed CKD prevalence was 56.9% 95%CI 53.7–60.0 and 48.0% 95%CI 45.2–50.8 in women; 54.0% 95%CI 49.9–58.1 and 49.6% 95%CI 46.0–53.3 in men, across the two periods. Mortality rate was 2.5 95%CI 1.9–3.3 times as high in women with CKD and 1.6 95%CI 1.3–2.1 times as high in men with CKD, compared to women or men without CKD. In women, estimated CKD incidence increased linearly from 25.6 95%CI 4.2–53.0 to 128.6 95%CI 77.1–196.6 with each 5-year age group up to 69 years, and to 99.8 95%CI 38.7–204.7 at age ≥70. In men, estimated CKD incidence increased form 28.5 95%CI 3.8–71.2 at age 20–24 years to 118.7 95%CI 23.6–336.7 at age ≥70. Age-sex-stratified estimated incidence reflected the magnitude and directional trend of the true incidence and were similar to the true incidence rates p>0.05 for difference except for age 20–24 in women p = 0.008 and age 25–29 in men p = 0.002. In conclusion, the estimated and observed incidence rates of CKD agree well over 25 years of observation in this well characterized population with type 2 diabetes.

Author: Pavithra Vijayakumar , Annika Hoyer , Robert G. Nelson, Ralph Brinks, Meda E. Pavkov



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