Dataset Information

Estimation of chronic kidney disease incidence from prevalence and mortality data in American Indians with type 2 diabetes.

ABSTRACT: 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.

SUBMITTER: Vijayakumar P

PROVIDER: S-EPMC5293194 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Estimation of chronic kidney disease incidence from prevalence and mortality data in American Indians with type 2 diabetes.

Vijayakumar Pavithra P Hoyer Annika A Nelson Robert G RG Brinks Ralph R Pavkov Meda E ME

PloS one 20170206 2

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 p ...[more]

PMID: 28166298

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Project description:BACKGROUND:A growing number of serum filtration markers are associated with mortality and end-stage renal disease (ESRD) in adults. Whether ?-trace protein (BTP) and ?2-microglobulin (B2M) are associated with these outcomes in adults with type 2 diabetes is not known. STUDY DESIGN:Longitudinal cohort study. SETTING & PARTICIPANTS:250 Pima Indians with type 2 diabetes (69% women; mean age, 42 years; mean diabetes duration, 11 years). PREDICTORS:Serum BTP, B2M, and glomerular filtration rate measured by iothalamate clearance (mGFR) or estimated using creatinine (eGFRcr) or cystatin C level (eGFRcys). OUTCOMES & MEASUREMENTS:Incident ESRD and all-cause mortality through December 2013. HRs were reported per interquartile range decrease of the inverse of BTP and B2M (1/BTP and 1/B2M) using Cox regression. Improvement in risk prediction with the addition of BTP or B2M level to established markers (eGFRcys with mGFR or eGFRcr) was evaluated using C statistics, continuous net reclassification improvement, and relative integrated discrimination improvement (RIDI). RESULTS:During a median follow-up of 14 years, 69 participants developed ESRD and 95 died. Both novel markers were associated with ESRD in multivariable models. BTP level remained statistically significant after further adjustment for mGFR (1/BTP, 1.53 [95% CI, 1.01-2.30]; 1/B2M, 1.54 [95% CI, 0.98-2.42]). B2M level was associated with mortality in multivariable models and after further adjustment for mGFR (HR, 2.12; 95% CI, 1.38-3.26). The addition of B2M level to established markers increased the C statistic for mortality but only weakly when assessed by either continuous net reclassification improvement or RIDI; none was improved for ESRD by the addition of these markers. LIMITATIONS:Small sample size, single measurements of markers. CONCLUSIONS:In Pima Indians with type 2 diabetes, BTP and, to a lesser extent, B2M levels were associated with ESRD. B2M level was associated with mortality after adjustment for traditional risk factors and established filtration markers. Further studies are warranted to confirm whether inclusion of B2M level in a multimarker approach leads to improved risk prediction for mortality in this population.

Project description:CKD disproportionally affects American Indians, who similar to other populations, show genetic susceptibility to kidney outcomes. Recent studies have identified several loci associated with kidney traits, but their relevance in American Indians is unknown.This study used data from a large, family-based genetic study of American Indians (the Strong Heart Family Study), which includes 94 multigenerational families enrolled from communities located in Oklahoma, the Dakotas, and Arizona. Individuals were recruited from the Strong Heart Study, a population-based study of cardiovascular disease in American Indians. This study selected 25 single nucleotide polymorphisms in 23 loci identified from recently published kidney-related genome-wide association studies in individuals of European ancestry to evaluate their associations with kidney function (estimated GFR; individuals 18 years or older, up to 3282 individuals) and albuminuria (urinary albumin to creatinine ratio; n=3552) in the Strong Heart Family Study. This study also examined the association of single nucleotide polymorphisms in the APOL1 region with estimated GFR in 1121 Strong Heart Family Study participants. GFR was estimated using the abbreviated Modification of Diet in Renal Disease Equation. Additive genetic models adjusted for age and sex were used.This study identified significant associations of single nucleotide polymorphisms with estimated GFR in or nearby PRKAG2, SLC6A13, UBE2Q2, PIP5K1B, and WDR72 (P<2.1 × 10(-3) to account for multiple testing). Single nucleotide polymorphisms in these loci explained 2.2% of the estimated GFR total variance and 2.9% of its heritability. An intronic variant of BCAS3 was significantly associated with urinary albumin to creatinine ratio. APOL1 single nucleotide polymorphisms were not associated with estimated GFR in a single variant test or haplotype analyses, and the at-risk variants identified in individuals with African ancestry were not detected in DNA sequencing of American Indians.This study extends the genetic associations of loci affecting kidney function to American Indians, a population at high risk of kidney disease, and provides additional support for a potential biologic relevance of these loci across ancestries.

Project description:Background:In the United States, the mortality burden of injury is higher among American Indians and Alaska Natives (AI/AN) than any other racial/ethnic group, and injury contributes to considerable medical costs, years of potential life lost (YPLL), and productivity loss among AI/AN.This study assessed the economic burden of injuries for AI/AN who are eligible for services through Indian Health Service, analyzing direct medical costs of injury for Indian Health Service's users and years of potential life lost (YPLL) and the value of productivity losses from injury deaths for AI/AN in the Indian Health Service population. Methods:Injury-related lifetime medical costs were estimated for Indian Health Service users with medically treated injuries using data from the 2011-2015 National Data Warehouse. Productivity costs and YPLL were estimated using data on injury-related deaths among AI/AN in Indian Health Service's 2008-2010 service population. Costs were reported in 2017?U.S. dollars. Results:The total estimated costs of injuries per year, including injuries among Indian Health Service users and productivity losses from injury-related deaths, were estimated at $4.5 billion. Lifetime medical costs to treat annual injuries among Indian Health Service users were estimated at $549 million, with the largest share ($131 million) going toward falls, the most frequent injury cause. Total estimated YPLL from AI/AN injury deaths in Indian Health Service's service population were 106,400. YPLL from injury deaths for men (74,000) were 2.2 times YPLL for women (33,000). Productivity losses from all injury-related deaths were $3.9 billion per year. The highest combined lifetime medical and mortality costs were for motor vehicle/traffic injuries, with an estimated cost of $1.6 billion per year. Conclusions:Findings suggest that targeted injury prevention efforts by Indian Health Service likely contributed to lower rates of injury among AI/AN, particularly for motor vehicle/traffic injuries. However, because of remaining disparities in injury-related outcomes between AI/AN and all races in the United States, Indian Health Service should continue to monitor changes in injury incidence and costs over time, evaluate the impacts of previous injury prevention investments on current incidence and costs, and identify additional injury prevention investment needs.

Dataset Information

Estimation of chronic kidney disease incidence from prevalence and mortality data in American Indians with type 2 diabetes.

Publications

Estimation of chronic kidney disease incidence from prevalence and mortality data in American Indians with type 2 diabetes.

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