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Abstract: FR-PO257

Anti-Diabetic Medication Use and Kidney Function in US Adults

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Murphy, Daniel P., University of Minnesota, Minneapolis, Minnesota, United States
  • Foley, Robert N., University of Minnesota, Minneapolis, Minnesota, United States
Background

The concordance of diabetes mellitus (DM) and chronic kidney disease (CKD) constitutes a major public health problem. Though notable therapeutic advances have occurred in the last decade, diabetes medication patterns in the U.S. DM-CKD population remain poorly delineated, particularly associations with declining kidney function. Hence, we examined anti-diabetic medication (ADM) use among adult National Health and Nutrition Examination Survey participants (2001 to 2016) with self-reported diabetes or HbA1c ≥ 7.0%.

Methods

Comparisons were based on two thresholds of creatinine-based estimated glomerular filtration rate (eGFR, 60 and 45 ml/min/1.73m2) and one threshold of urinary albumin to creatinine ratio (ACR, 30 mg/g).

Results

Renal function in US adults with DM was distributed as follows: eGFR ≥ 60 and ACR < 30 (≥ 60/<30)~60.1%, ≥ 60/≥30~20.1%, 45-59/<30~7.4%,45-59/≥30~3.9%, <45/<30~3.1% and <45/≥30~5.4%. Use of ≥ 1 ADM was more prevalent with CKD than without kidney dysfunction (79.5% vs. 75.3%, P=0.004). Following these same eGFR and ACR categories, use of ≥ 1 ADM was associated with worsening kidney function category (75.3%, 75.4%, 82%, 84.5%,80.9%, and 86.7%, P < 0.001), as were sulphonylurea (26.3%, 33.3%, 29.5%, 29.9%, 36.7%, and 36.5%, P=0.002), insulin (23.3%, 27.3%, 30.9%, 41.0%, 40.6%, and 54.3%, P < 0.001) and amylin analog (0%, 0.6%, 0%, 0%, 0%, and 1.2%, P=0.03) use. Worsening kidney function category was associated with lower proportions of ≥ 2 ADM (35.6%, 41.5%, 34.0%, 38.9%, 26.4%, and 33.2%, P=0.032), biguanide (51.8%, 50.7%, 40.9%, 41.3%,16.4%, and 11.2%, P < 0.001) and SGLT-2 inhibitor (2.9%, 1.8%, 0.9%, 1.3%, 1%, and 0.1%, P=0.044) use. No association was present for thiazolidinedione, dipeptidyl peptidase-4 inhibitor, alpha-glucosidase inhibitor, GLP-1 receptor agonist and meglitinide use.

Conclusion

One in five in the U.S. DM-CKD population do not use anti-diabetic medications, and medication patterns vary substantially with kidney function.