Chronic kidney disease and diabetes in the national health service: a cross-sectional survey of the U.K. national diabetes audit

Diabet Med. 2014 Apr;31(4):448-54. doi: 10.1111/dme.12312. Epub 2013 Oct 1.

Abstract

Aims: We investigated the prevalence of chronic kidney disease and attainment of therapeutic targets for HbA1c and blood pressure in a large U.K.-based diabetes population.

Methods: The U.K. National Diabetes Audit provided data from 1 January 2007 to 31 March 2008. Inclusion criteria were a documented urinary albumin:creatinine ratio and serum creatinine. Patients were stratified according to chronic kidney disease stage and albuminuria status. Chronic kidney disease was defined as an estimated glomerular filtration rate < 60 ml min(-1) 1.73 m(-2) , albuminuria or both. The proportions of patients achieving nationally defined glycaemic and systolic blood pressure targets were determined.

Results: The cohort comprised 1,423,669 patients, of whom 868,616 (61%) met inclusion criteria. Of the patients analysed, 92.2% had Type 2 diabetes. A higher proportion of people with Type 2 diabetes (42.3%) had renal dysfunction compared with those with Type 1 diabetes (32.4%). Achievement of systolic blood pressure and HbA1c targets was poor. Among people with Type 1 diabetes, 67.8% failed to achieve an HbA1c < 58 mmol/mol (7.5%). Of all people with diabetes, 37.8% failed to achieve a systolic blood pressure < 140 mmHg. Blood pressure control was poor in advanced chronic kidney disease. For example, mean (standard deviation) systolic blood pressure rose from 128.6 (15.4) mmHg among people with Type 1 diabetes and normal renal function to 141.0 (23.6) mmHg in those with chronic kidney disease stage 5 and macroalbuminuria.

Conclusions: The high prevalence of chronic kidney disease and poor attainment of treatment targets highlights a large subset of the diabetes population at increased risk of cardiovascular mortality or progressive kidney disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Albuminuria / epidemiology
  • Cohort Studies
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetic Nephropathies / epidemiology*
  • Diabetic Nephropathies / urine
  • Female
  • Glomerular Filtration Rate
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypertension / epidemiology
  • Hypertension / therapy
  • Male
  • Medical Audit
  • Middle Aged
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / urine
  • Risk Factors
  • Severity of Illness Index
  • State Medicine
  • Treatment Outcome
  • United Kingdom / epidemiology

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human