Association and risk factors of chronic kidney disease and incident diabetes: a nationwide population-based cohort study
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.
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.
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).
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.
KeywordsChronic kidney disease CKD Competing-risk regression Incident diabetes mellitus Insulin resistance New-onset diabetes mellitus
Chronic kidney disease
Estimated glomerular filtration rate
End-stage renal disease
National Health Insurance
National Health Insurance Research Database
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.
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.
- 1.Kuo KL, Hung SC, Liu JS et al (2015) Add-on protective effect of pentoxifylline in advanced chronic kidney disease treated with renin-angiotensin-aldosterone system blockade—a nationwide database analysis. Sci Rep 5(1):17150. https://doi.org/10.1038/srep17150 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Friedman JE, Dohm GL, Elton CW et al (1991) Muscle insulin resistance in uremic humans: glucose transport, glucose transporters, and insulin receptors. Am J Phys 261:E87–E94Google Scholar
- 14.Hsu TW, Liu JS, Hung SC et al (2014) Renoprotective effect of renin-angiotensin-aldosterone system blockade in patients with predialysis advanced chronic kidney disease, hypertension, and anemia. JAMA Intern Med 174(3):347–354. https://doi.org/10.1001/jamainternmed.2013.12700 CrossRefPubMedGoogle Scholar