Risk of chronic kidney disease in young adults with impaired glucose tolerance/impaired fasting glucose: a retrospective cohort study using electronic primary care records.

Jadhakhan, Ferozkhan Marshall, Tom Ryan, Ronan Gill, Paramjit

REVIEW


12 May 2018

This work has limited clinical applicability. IGT and IFG are pre-diabetes states. When we intervene in these populations, we are able to prevent diabetes which the precursor condition for CKD, retinopathies, CVD, CVAs and amputations. Therefore, what is the clinical utility of analysing the association of pre-diabetes state on only CKD and not the other complications of diabetes? Are the authors suggesting there is direct association of IFG and IGT with CKD independent of blood sugar concentrations?


RELEVANCE 2
INNOVATIVENESS 3
APPLICABILITY 1
OVERALL 2

PAPER DETAILS


TITLE

Risk of chronic kidney disease in young adults with impaired glucose tolerance/impaired fasting glucose: a retrospective cohort study using electronic primary care records.

ABSTRACT

BACKGROUND
The risk of chronic kidney disease (CKD) is known to be elevated in patients with diabetes mellitus but the risk of young adults aged 18 to 40 years with impaired glucose tolerance/impaired fasting glucose (IGT/IFG) developing CKD is not well characterised. Furthermore, progression of IGT/IFG to diabetes and subsequent CKD development is not well understood.

METHODS
A retrospective cohort study was undertaken using The Health Improvement Network (THIN) database, a large dataset of electronic patient records. THIN database is jointly managed by IMS Health Real World Evidence Solution ( http://www.epic-uk.org/index.html ) and In Practice System (InPs). Cases were aged 18 to 40, with a diagnosis of IGT/IFG and registered at a practice contributing to THIN between 2000 and 2015. The study population consisted of 40,092 patients, including 21,454 (53.5%) female and 18,638 (46.5%) male. The median follow-up was approximately 2 years. The outcome was a diagnosis of CKD determined from either clinical coding or laboratory results. For the primary analysis the unadjusted and adjusted relative risk of CKD in IGT/IFG was compared to age, sex and practice matched controls with normoglycaemia. For the secondary analysis we compared the incidence of CKD before to after a diagnosis of type 2 diabetes (T2DM) in the IGT/IFG study cohort.

RESULTS
The Incidence Rate Ratio (IRR) for CKD for IGT/IFG compared to normoglycaemia was 4.0 [95% confidence interval (CI), 3.2 to 5.1, P < 0.001]. The adjusted IRR was 2.6 [95% CI, 2.0 to 3.4, P < 0.001]. The unadjusted IRR was 8.8 [95% CI, 7.7 to 10.0, P < 0.001] after IGT/IFG patients had developed T2DM and the adjusted IRR was 6.3 [95% CI, 5.5 to 7.2, P < 0.001].

CONCLUSION
Our results show that young IGT/IFG subjects are also at higher risk of developing CKD. This risk is modulated by the degree of baseline renal function and glucose tolerance, being higher in those developing T2DM.



AUTHOR(S)

Jadhakhan, Ferozkhan Marshall, Tom Ryan, Ronan Gill, Paramjit

JOURNAL

BMC nephrology

PLACE

England