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Diabetologia

, Volume 62, Issue 3, pp 438–447 | Cite as

Association and risk factors of chronic kidney disease and incident diabetes: a nationwide population-based cohort study

  • Ching-Yeh Lin
  • Ming-Chia Hsieh
  • Chew-Teng Kor
  • Yao-Peng HsiehEmail author
Article

Abstract

Aims/hypothesis

Chronic kidney disease (CKD) is a known complication of diabetes mellitus, and insulin resistance is a well-known complication of CKD. However, there is no consensus in the published data on the association of CKD with incident diabetes.

Methods

A total of 15,403 people with CKD were identified from the Taiwan National Health Insurance Research Database to determine their risk of incident diabetes compared with that of 15,403 matched individuals without CKD. Fine and Gray regression models using death as a competing risk were performed to calculate adjusted HRs and 95% CIs. Risk factors for incident diabetes in people with CKD were also determined.

Results

The CKD cohort had a higher incidence rate of diabetes compared with the non-CKD cohort (11.23/1000 person-years vs 8.93/1000 person-years). In the fully adjusted model, CKD was a significant and independent predictor of incident diabetes (adjusted HR 1.204; 95% CI 1.11, 1.31). The influence of CKD on incident diabetes showed consistent results in three levels of sensitivity analysis. In the CKD cohort, the significant risk factors for incident diabetes included increased age, geographical location, hypertension, hyperlipidaemia and gout. Of these, hypertension was associated with the highest risk of developing incident diabetes (adjusted HR 1.682; 95% CI 1.47, 1.93).

Conclusions/interpretation

People with CKD were at higher risk of developing incident diabetes. People with CKD and hypertension, hyperlipidaemia, increased age or gout and who lived in certain geographical regions of Taiwan were more likely to develop diabetes as a complication compared with people without those characteristics.

Keywords

Chronic kidney disease CKD Competing-risk regression Incident diabetes mellitus Insulin resistance New-onset diabetes mellitus 

Abbreviations

CKD

Chronic kidney disease

eGFR

Estimated glomerular filtration rate

ESRD

End-stage renal disease

NHI

National Health Insurance

NHIRD

National Health Insurance Research Database

Notes

Contribution statement

YPH conceived and designed the experiments and wrote the paper. CYL, CTK and MCH analysed the data and revised the manuscript. All authors read and approved the manuscript prior to submission. YPH is responsible for the integrity of the work as a whole.

Funding

This study was funded by grant 107-CCH-HCR-031 from the Changhua Christian Hospital Research Foundation.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ching-Yeh Lin
    • 1
  • Ming-Chia Hsieh
    • 1
  • Chew-Teng Kor
    • 1
  • Yao-Peng Hsieh
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Internal MedicineChanghua Christian HospitalChanghua CityTaiwan
  2. 2.School of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
  3. 3.School of MedicineChung Shan Medical UniversityTaichungTaiwan

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