Kidney Week

Abstract: SA-PO1099

Kidney Prognostic Role of a Temporal Relationship between Onset of Diabetes and Hypertension in Patients with Coexisting Diabetes and Hypertension

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 3
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Song, Seungmin, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Seungmin Song, MD

• Lee, Kyungho, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Kyungho Lee, MD, PhD

• Kim, Minhyung, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Minhyung Kim, MD

• Jeon, Junseok, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Junseok Jeon, MD, PhD

• Lee, Jung eun, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Jung eun Lee, MD, PhD

• Huh, Wooseong, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Wooseong Huh, MD, PhD

• Jang, Hye Ryoun, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Hye Ryoun Jang, MD, PhD

Background

Diabetes and hypertension are well-established risk factors for chronic kidney disease(CKD) and end-stage kidney disease(ESKD). These conditions frequently coexist, potentially due to bidirectional mechanisms. Prognostic differences between hypertension preceding diabetes and diabetes preceding hypertension remain unclear. We aimed to evaluate whether onset of diabetes before or after hypertension differentially influences risk of developing ESKD.

Methods

We identified all adult patients with diabetes and hypertension who participated in national health insurance service(NHIS) in Korea between 2015 and 2016. Patients were categorized into two groups based on order of onset of diabetes and hypertension: those with diabetes preceding hypertension(termed “diabetes first”) and hypertension preceding diabetes(termed “hypertension first”). Demographic and laboratory data were obtained from NHIS database. Cox proportional hazards analyses were performed for ESKD.

Results

Among 995,484 patients, 468,072(47%) and 527,412(53%) developed diabetes and hypertension first, respectively. Incidence rates for ESKD were 4.53 in diabetes first group and 1.46 in hypertension first group(1,000 person-years, log-rank p<0.001). In unadjusted analysis, diabetes first group had a 3.10-fold(95%CI 2.99–3.22) higher risk of developing ESKD compared to hypertension first group. After adjusting for multiple covariates, including demographics, lifestyle factors, dyslipidemia, eGFR, blood pressure, blood glucose levels, proteinuria, duration of diabetes and hypertension, adjusted hazard ratio for ESKD was 1.55(95%CI 1.49–1.61) for diabetes first group. Stratified analyses by glucose and blood pressure status consistently showed an increased risk in diabetes first group. Subgroup analyses revealed significant interactions with age, smoking status, and CKD status, with stronger risks in younger patients, current smokers, and non-CKD.

Conclusion

In patients with coexisting hypertension and diabetes, sequence in which these conditions develop plays a significant prognostic role in predicting risk of ESKD. An earlier onset of diabetes than hypertension is associated with a higher risk. Considering order of onset of each condition could be a practical approach to enhance kidney-focused prognostication.