Five-year morbidity and mortality rates in a U.S. population with obesity with and without prediabetes

AIMS

This research examines the prevalence of morbidity and mortality among people with obesity with or without prediabetes.

METHODS

This observational study uses Optum® Market Clarity deidentified data from 2007 to 2020. Individuals with obesity without prediabetes (obesity only) were matched 1:1 to adults with prediabetes plus obesity based upon age, sex, race, ethnicity, and region. Age and sex adjusted prevalence rates and 95 % CIs were calculated for morbidity and mortality for each 365-day period post index date and over the entire 5-year post-period.

RESULTS

After 5-years, the adjusted mortality rate was 10.1 % for adults with obesity plus prediabetes and 6.9 % for adults with obesity only (p < 0.05). Five years post index date, the prevalence of type 2 diabetes was 25.3 % for people with obesity plus prediabetes and 9.2 % for people with obesity only (p < 0.05). Prevalence rates after 5 years for atherosclerotic cardiovascular disease (13.1 % v 8.1 %), composite cardiovascular outcome (7.0 % v 4.4 %) and composite cardio-renal outcome (8.9 % v 5.0 %) were significantly higher for adults with obesity plus prediabetes compared to adults with obesity only (all p < 0.05).

CONCLUSIONS

Results of this study indicate that the presence of prediabetes contributes to the development of additional morbidity and mortality in adults with obesity.

Development and Validation of Prediction Models for Hypertensive Nephropathy, the PANDORA Study

Importance

Hypertension is a leading cause of end-stage renal disease (ESRD), but currently, those at risk are poorly identified.

Objective

To develop and validate a prediction model for the development of hypertensive nephropathy (HN).

Design, Setting, and Participants

Individual data of cohorts of hypertensive patients from Kailuan, China served to derive and validate a multivariable prediction model of HN from 12, 656 individuals enrolled from January 2006 to August 2007, with a median follow-up of 6.5 years. The developed model was subsequently tested in both derivation and external validation cohorts.

Variables

Demographics, physical examination, laboratory, and comorbidity variables.

Main Outcomes and Measures

Hypertensive nephropathy was defined as hypertension with an estimated glomerular filtration rate (eGFR) &lt; 60 ml/min/1.73 m2 and/or proteinuria.

Results

About 8.5% of patients in the derivation cohort developed HN after a median follow-up of 6.5 years that was similar in the validation cohort. Eight variables in the derivation cohort were found to contribute to the risk of HN: salt intake, diabetes mellitus, stroke, serum low-density lipoprotein, pulse pressure, age, hypertension duration, and serum uric acid. The discrimination by concordance statistics (C-statistics) was 0.785 (IQR, 0.770-0.800); the calibration slope was 1.129, the intercept was –0.117; and the overall accuracy by adjusted R2 was 0.998 with similar results in the validation cohort. A simple points scale developed from these data (0, low to 40, high) detected a low morbidity of 7% in the low-risk group (0–10 points) compared with &gt;40% in the high-risk group (&gt;20 points).

Conclusions and Relevance

A prediction model of HN over 8 years had high discrimination and calibration, but this model requires prospective evaluation in other cohorts, to confirm its potential to improve patient care.

Renal Dysfunction in Prediabetes: Confirmed by Glomerular Hyperfiltration and Albuminuria

Objectives Prediabetes is defined as an intermediate state of hyperglycemia with glucose levels above normal but below the diagnostic cutoff of diabetes mellitus. Prediabetes is considered as an important risk factor for the development of diabetes and complications associated with diabetes. Since glomerular hyperfiltration (elevated GFR) and albuminuria represent early and reversible stages of kidney damage seen in patients with type 2 diabetes, we aim to assess the impact of hyperglycemia in prediabetic range on renal functions measured by estimated GFR and urine albumin excretion (UAE).

Materials and Methods The study included 1,031 patients aged 30 to 70 years, attending regular health checkup. Patients were grouped as normal, prediabetes, and diabetes according to the American Diabetic Association (ADA) criteria based on fasting blood sugar and hemoglobin A1c (HbA1c). Further, the patients were grouped into multiple subgroups based on age and gender. UAE was measured by using immunoturbidimetric method, and GFR was estimated by chronic kidney disease epidemiology collaboration (CKD EPI) equation.

Statistical Analysis Prevalence of hyperfiltration (estimated glomerular filtration rate above the age and gender specific 95th percentile), and albuminuria in prediabetes and diabetes was compared with normal controls. Odds ratio and 95% confidence interval were calculated by using logistic regression analysis to predict the occurrence of hyperfiltration in prediabetes and diabetes. Analysis of variance followed by post hoc comparison was done to assess the significance of difference, and p -value < 0.05 was considered statistically significant.

Results Prevalence of hyperfiltration was more in prediabetes and diabetes compared with normal controls, and it increased with surging HbA1c level that was shown as higher odds ratio for hyperfiltration in both the groups. UAE was more in the prediabetes and diabetes group when compared with normal controls, but the difference was significant only in diabetes.

Conclusion Since glomerular hyperfiltration represents an early and reversible stage of renal damage manifesting before the appearance of albuminuria, elevated GFR can be used to identify asymptomatic patients with intermediate hyperglycemia having high risk of developing nephropathy in the future. Prediabetes represents a window of opportunity to initiate preventive strategies at an early stage before the occurrence of significant renal damage.

Chronic Microvascular Complications in Prediabetic States-An Overview

A prediabetic state is a major risk factor for the development of diabetes, and, because of an identical pathophysiological background of both conditions, their prevalence increases parallelly and equally fast. Long-term hyperglycemia is the main cause inducing chronic complications of diabetes, yet the range of glucose levels at which they start has not been yet unequivocally determined. The current data show that chronic microvascular complications of diabetes can be observed in patients with abnormal glucose metabolism in whom glycaemia is higher than optimal but below diagnostic criteria for diabetes. Prediabetes is a heterogenous nosological unit in which particular types are differently characterized and show different correlations with particular kinds of complications. Analysis of the latest research results shows the need to continue studies in a larger population and can imply the need to verify the currently employed criteria of diagnosing diabetes and chronic complications of diabetes in people with prediabetes.

Prediabetes and associated disorders

Prediabetes represents an elevation of plasma glucose above the normal range but below that of clinical diabetes. Prediabetes includes individuals with IFG, IGT, IFG with IGT and elevated HbA1c levels. Insulin resistance and β-cell dysfunction are characteristic of this disorder. The diagnosis of prediabetesis is vital as both IFG and IGT are indeed well-known risk factors for type 2 diabetes with a greater risk in the presence of combined IFG and IGT. Furthermore, as will be illustrated in this review, prediabetes is associated with associated disorders typically only considered in with established diabetes. These include cardiovascular disease, periodontal disease, cognitive dysfunction, microvascular disease, blood pressure abnormalities, obstructive sleep apnea, low testosterone, metabolic syndrome, various biomarkers, fatty liver disease, and cancer. As the vast majority of individuals with prediabetes are unaware of their diagnosis, it is therefore vital that the associated conditions are identified, particularly in the presence of mild hyperglycemia, so they may benefit from early intervention.

Association between management of metabolic syndrome and progression of early-stage chronic kidney disease: an observational cohort study

OBJECTIVES

To analyze the effect of treating metabolic syndrome (MetS) on further kidney function decline in patients with early-stage chronic kidney disease (CKD).

METHODS

In a study period of 24 months, 162 patients with early stage CKD were enrolled. Baseline and follow-up data related to the occurrence of MetS and glomerular filtration rate (GFR) were assessed. Subjects were classified into controlled MetS (group 1) and uncontrolled MetS (group 2). Furthermore, they were subdivided into four subgroups: (A) controlled MetS at baseline and at follow-up, (B) uncontrolled MetS at baseline but controlled MetS at follow-up visits, (C) controlled MetS at baseline but uncontrolled MetS at follow-up visits, and (D) uncontrolled MetS at baseline and follow-up visits.

RESULTS

Final GFR was lower in group 2 versus group 1 (69.21 ± 20.20 vs. 82.86 ± 22.33 mL/min/1.73 m(2), p <0.001). The presence of MetS had high risk to develop late-stage CKD (HR = 3.279, 95% CI: 1.545-6.958, p = 0.002). Moreover, subgroup D (HR = 2.982, 95% CI: 1.287-6.908, p = 0.011) and the presence of three (p = 0.026) or four (p = 0.049) metabolic components had high risk to develop late-stage CKD.

CONCLUSION

Treating MetS slows CKD progression in patients with early-stage of CKD.

Hypertriglyceridemic waist phenotype and chronic kidney disease in a Chinese population aged 40 years and older

Objective

To examine the relationship between the HW phenotype and risk for CKD in a community population aged 40 years and older.

Methods

A cross-sectional study was conducted in Zhuhai from June to October 2012. The participants were divided into three groups: Group 1, Waist circumference >90 cm in men or >85 cm in women and triglycerides ≥2 mmol/l; Group 3, Waist circumference ≤90 cm in men or ≤85 cm in women and triglycerides <2 mmol/l; Group 2, The remaining participants. The prevalence of the three subgroups and CKD were determined. The association between HW phenotype and CKD was then analyzed using SPSS (version 13.0).

Results

After adjusting for age and sex, Group 1 was associated with CKD (OR 3.08, 95% CI 2.01, 4.73, P<0.001), when compared with Group 3. Further adjustment for factors which were potential confounders and unlikely to be in the causal pathway between the HW phenotype and CKD, Group 1 was still significantly associated with CKD. The OR for CKD was 2.65 (95% CI 1.65, 4.26, P<0.001). When adjusted for diabetes and hypertension, the association of Group 1 and CKD was still significant (OR 2.09, 95% CI 1.26, 3.45, P = 0.004). Group 2 was associated with CKD (OR 1.81, 95% CI 1.29, 2.53, P = 0.001), when compared with Group 3. Further adjustment for factors which were potential confounders, Group 2 was still significantly associated with CKD. The OR for CKD was 1.75 (95% CI 1.22, 2.51, P = 0.002). When adjusted for diabetes and hypertension, the association between Group 2 and CKD still existed. The OR for CKD was 1.48 (95% CI 1.01, 2.16, P = 0.046).

Conclusion

Our results showed that HW phenotype was associated with CKD in the population aged 40 years and older.

The number of metabolic syndrome components is a good risk indicator for both early- and late-stage kidney damage

BACKGROUND AND AIMS

Renal hyperfiltration (early-stage kidney damage) and hypofiltration (late-stage kidney damage) are common in populations at high risk of chronic kidney disease. This study investigated the associations of renal hyperfiltration and hypofiltration with the number of metabolic syndrome (MetS) components.

METHODS AND RESULTS

The study subjects included 205,382 people aged 40-74 years who underwent Specific Health Checkups in Aichi Prefecture, Japan. The prevalence of renal hyperfiltration [estimated glomerular filtration rate (eGFR) above the age-/sex-specific 95th percentile] and hypofiltration (eGFR below the 5th percentile) was compared according to the number of MetS components. We found that the prevalence of both hyperfiltration and hypofiltration increased with increasing number of MetS components (odds ratios for hyperfiltration: 1.20, 1.40, 1.42, 1.41, and 1.77; odds ratios for hypofiltration: 1.07, 1.25, 1.57, 1.89, and 2.21 for one, two, three, four, and five components, respectively, compared with no MetS components). These associations were observed in both normal weight [body mass index (BMI) < 25 kg/m(2)] and overweight (BMI ≥ 25 kg/m(2)) subjects. Renal hyperfiltration was associated with prehypertension and prediabetes, while hypofiltration was associated with dyslipidemia, abdominal obesity, overt hypertension, and overt diabetes.

CONCLUSION

The number of MetS components is a good risk indicator of early- and late-stage kidney damage. Therefore, kidney function should be monitored in subjects with MetS components. MetS components should be treated as early as possible to prevent the development of kidney damage and cardiovascular diseases in people with hyperfiltration, regardless of their body weight.

Association between metabolic syndrome and chronic kidney disease in perimenopausal women

The purpose of the study was to explore the association between metabolic syndrome (MetS) and chronic kidney disease (CKD) in perimenopausal women. A cross-sectional study was conducted in Zhuhai from June to October 2012. Perimenopausal women (n = 685) were included in the study. All participants were divided into three subgroups: Group 1, 40 years old ≤ Age < 50 years old; Group 2, 50 years old ≤ Age < 60 years old; Group 3, 60 years old ≤ Age ≤ 65 years old. MetS was associated with CKD (p < 0.01) in the unadjusted analyses in total subjects. After adjusting the potential confounders, the odd ratios of CKD for MetS was 2.66 (95% CI 1.56 to 4.49, p < 0.001). There was no relationship between MetS and CKD in both Group 1 and Group 3. MetS was associated with CKD (p < 0.001) in the unadjusted analyses in Group 2. After adjusting for potential confounders, MetS was significantly associated with CKD. The odd ratios for MetS was 6.79 (95% CI 2.30 to 20.09, p < 0.001). There was no relationship between elevated blood pressure, elevated fasting glucose, abdominal obesity, Low HDL cholesterol, elevated triglycerides and CKD in both Group 1 and Group 3. Elevated blood pressure was associated with CKD in Group 2 (unadjusted Odds ratio: 4.52 (1.28-16.02), p = 0.02). After adjusting for potential confounders, there was no relationship between elevated blood pressure and CKD (p = 0.78). Elevated fasting glucose was associated with CKD in Group 2 (unadjusted Odds ratio: 3.69 (1.10-12.38), p = 0.03). After adjusting for potential confounders, there was no relationship between elevated fasting glucose and CKD (p = 0.15). There was no relationship between abdominal obesity, Low HDL cholesterol, elevated triglycerides and CKD in Group 2. These findings suggest that in perimenopausal women aged from 50 or older to 60 MetS was associated with CKD. There is no relationship between MetS and CKD in perimenopausal women aged from 40 or older to 50 and aged from 60 or older to 65.

A risk score for chronic kidney disease in the general population

BACKGROUND

Stratification of individuals at risk for chronic kidney disease may allow optimization of preventive measures to reduce disease incidence and complications. We sought to develop a risk score that estimates an individual's absolute risk of incident chronic kidney disease.

METHODS

Framingham Heart Study participants free of baseline chronic kidney disease, who attended a baseline examination in 1995-1998 and follow-up in 2005-2008, were included in the analysis (n = 2490). Chronic kidney disease was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2) using the Modification of Diet in Renal Disease equation. Participants were assessed for the development of chronic kidney disease at 10 years follow-up. Stepwise logistic regression was used to identify chronic kidney disease risk factors, and these were used to construct a risk score predicting 10-year chronic kidney disease risk. Performance characteristics were assessed using calibration and discrimination measures. The final model was externally validated in the bi-ethnic Atherosclerosis Risk in Communities Study (n = 1777).

RESULTS

There were 1171 men and 1319 women at baseline, and the mean age was 57.1 years. At follow-up, 9.2% (n = 229) had developed chronic kidney disease. Age, diabetes, hypertension, baseline estimated glomerular filtration rate, and albuminuria were independently associated with incident chronic kidney disease (P <.05), and these covariates were incorporated into a risk function (c-statistic 0.813). In external validation in the ARIC study, the c-statistic was 0.74 in whites (n = 1353) and 0.75 in blacks (n = 424).

CONCLUSION

Risk stratification for chronic kidney disease is achievable using a risk score derived from clinical factors that are readily accessible in primary care. The utility of this score in identifying individuals in the community at high risk of chronic kidney disease warrants further investigation.

Glomerular hyperfiltration in prediabetes and prehypertension

BACKGROUND

This study aimed to investigate the associations of hyperfiltration and hypofiltration with prediabetes and prehypertension.

METHODS

The study subjects included 99 140 people aged 20-89 years who underwent health checkups in Aichi Prefecture, Japan. The prevalence of hyperfiltration [estimated glomerular filtration rate (eGFR) above the age-/sex-specific 95th percentile] and hypofiltration (eGFR below the age-/sex-specific 5th percentile) was compared among stages of prediabetes (fasting plasma glucose <100, 100-109, 110-125 and ≥126 mg/dL for no prediabetes, Stage 1 prediabetes, Stage 2 prediabetes and diabetes, respectively) and prehypertension [blood pressure (BP) <120/80, 120-129/80-84, 130-139/85-89 and ≥140/90 mmHg for no prehypertension, Stage 1 prehypertension, Stage 2 prehypertension and hypertension, respectively).

RESULTS

The prevalence of hyperfiltration increased with increasing stage of prediabetes [odds ratios (ORs): 1.29, 1.58 and 2.47 for Stage 1 prediabetes, Stage 2 prediabetes and diabetes, respectively] and prehypertension (ORs: 1.10, 1.33 and 1.52 for Stage 1 prehypertension, Stage 2 prehypertension and hypertension, respectively). Hypofiltration was not associated with prediabetes or prehypertension.

CONCLUSIONS

The prevalence of glomerular hyperfiltration increased with increasing stages of prediabetes and prehypertension. Therefore, kidney function should be monitored in subjects with prediabetes or prehypertension. In subjects with hyperfiltration, earlier treatment of hyperglycemia and high BP may be necessary to prevent the development of kidney damage.

Subclinical atherosclerotic changes related to chronic kidney disease in asymptomatic black and white young adults: the Bogalusa heart study

PURPOSE

Chronic kidney disease (CKD) remains asymptomatic until its late stage, and also significantly increases the risk of cardiovascular (CV) disease morbidity and mortality. However, information in scant on the prevalence of CKD, and its association with subclinical atherosclerosis as depicted by carotid intima media thickness (IMT) in younger adults.

METHODS

This cross-sectional study included 1193 participants (43% males, 30% blacks) aged 23 to 43 years, residing in the semi-rural biracial (black-white) community of Bogalusa, Louisiana. The measured variables include estimated glomerular filtration rate (eGFR) to determine functional renal changes and urine album creatinine ratio to diagnose albuminuria, along with CV risk factor variables, and both segmental and composite carotid IMT.

RESULTS

Ninety-nine (8.5%) subjects had CKD, with blacks showing higher prevalence than whites (p = .01). Subjects with albuminuria had significantly greater internal carotid IMT (p = .03), common carotid IMT (p = .005), and composite carotid IMT (p = .04) than those without. In the multivariate logistic regression model, albuminuria was associated with black race (odds ratio [OR], 1.92; p = .005), female gender (OR, 2.24; p = .002), diabetes (OR, 6.26; p < .001), hypertension (OR, 2.36; p < .001), obesity (OR, 1.73; p = 0.02), and composite carotid IMT (OR, 1.83; p = .02), after adjusting for age. However, reduction in eGFR did not show significant independent association with carotid IMT.

CONCLUSION

Among asymptomatic young adults, subclinical atherosclerosis and structural renal damage depicted by albuminuria coexist, which has implications for early prevention and control.

Racial and ethnic differences in kidney function decline among persons without chronic kidney disease

Whether the rate of kidney function decline before the onset of CKD differs among racial and ethnic groups remains unclear. Here, we evaluated kidney function decline and incident CKD among white, black, Hispanic, and Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA) during 5 years of follow-up. We estimated GFR using both cystatin C (eGFRcys) and creatinine (eGFRcreat). The definition of incident CKD required eGFRcys <60 ml/min per 1.73 m(2) and a decline in eGFRcys ≥1 ml/min per year. Among participants with eGFRcreat >60 ml/min per 1.73 m(2) at baseline, blacks had a significantly higher rate of kidney function decline than whites (0.31 ml/min per 1.73 m(2)/yr faster on average, P=0.001), even after adjusting for multiple potential confounders. Among Hispanics, Dominicans and Puerto Ricans had faster rates of decline than whites (0.55 and 0.47 ml/min per 1.73 m(2)/yr faster, respectively). Mexicans, South Americans, or other Hispanics had similar rates of decline compared to whites. We did not detect significant differences in the rates of kidney function decline among Chinese and white participants. Among those with normal or near-normal kidney function at baseline, blacks and Hispanics had the highest rates of incident CKD during follow-up. Adjustment for comorbidities attenuated some of these differences. In conclusion, the average rate of kidney function decline before the onset of CKD differs among racial and ethnic groups. Traditional risk factors do not explain these differences fully, highlighting the need to explore these disparities.