High Incidence of Chronic Kidney Disease among Iranian Diabetic Adults: Using CKD-EPI and MDRD Equations for Estimated Glomerular Filtration Rate

Background@#To investigate the population based incidence rate of chronic kidney disease (CKD) and its potential risk factors among Iranian diabetic adults during over 14 years of follow-up. @*Methods@#Two different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] and Modification of Diet in Renal Disease [MDRD]) were applied for the calculating the estimated glomerular filtration rate (eGFR). Among a total of 1,374 diabetic Tehranian adults, 797 and 680 individuals were eligible for CKD-EPI and MDRD analyses, respectively. CKD was defined as eGFR lower than 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for all potential risk factors. @*Results@#The incidence rates (95% CI) of CKD per 1,000 person-years were 43.84 (39.49 to 48.66) and 55.80 (50.29 to 61.91) based on CKD-EPI and MDRD equations, respectively. Being older, a history of cardiovascular disease, and having lower levels of eGFR were significant risk factors in both equations. Moreover, in CKD-EPI, using glucose-lowering medications and hypertension, and in MDRD, female sex and fasting plasma glucose ≥10 mmol/L were also independent risk factors. Regarding the discrimination index, CKD-EPI equation showed a higher range of C-index for the predicted probability of incident CKD in the full-adjusted model, compared to MDRD equation (0.75 [0.72 to 0.77] vs. 0.69 [0.66 to 0.72]). @*Conclusion@#We found an incidence rate of more than 4%/year for CKD development among our Iranian diabetic population. Compared to MDRD, it can be suggested that CKD-EPI equation can be a better choice to use for prediction models of incident CKD among the Iranian diabetic populations.

High Incidence of Chronic Kidney Disease among Iranian Diabetic Adults: Using CKD-EPI and MDRD Equations for Estimated Glomerular Filtration Rate

Background@#To investigate the population based incidence rate of chronic kidney disease (CKD) and its potential risk factors among Iranian diabetic adults during over 14 years of follow-up. @*Methods@#Two different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] and Modification of Diet in Renal Disease [MDRD]) were applied for the calculating the estimated glomerular filtration rate (eGFR). Among a total of 1,374 diabetic Tehranian adults, 797 and 680 individuals were eligible for CKD-EPI and MDRD analyses, respectively. CKD was defined as eGFR lower than 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for all potential risk factors. @*Results@#The incidence rates (95% CI) of CKD per 1,000 person-years were 43.84 (39.49 to 48.66) and 55.80 (50.29 to 61.91) based on CKD-EPI and MDRD equations, respectively. Being older, a history of cardiovascular disease, and having lower levels of eGFR were significant risk factors in both equations. Moreover, in CKD-EPI, using glucose-lowering medications and hypertension, and in MDRD, female sex and fasting plasma glucose ≥10 mmol/L were also independent risk factors. Regarding the discrimination index, CKD-EPI equation showed a higher range of C-index for the predicted probability of incident CKD in the full-adjusted model, compared to MDRD equation (0.75 [0.72 to 0.77] vs. 0.69 [0.66 to 0.72]). @*Conclusion@#We found an incidence rate of more than 4%/year for CKD development among our Iranian diabetic population. Compared to MDRD, it can be suggested that CKD-EPI equation can be a better choice to use for prediction models of incident CKD among the Iranian diabetic populations.

The 10-year trend of adult diabetes, prediabetes and associated risk factors in Tehran: Phases 1 and 4 of Tehran Lipid and Glucose Study.

BACKGROUND: Type 2 diabetes is a global problem with significant morbidity and healthcare costs. In this study, we aimed to determine the 10-year trend of diabetes, prediabetes and their risk factors in the adult urban population of Tehran Lipid and Glucose Study (TLGS). MATERIALS AND METHODS: In this cross-sectional study, we included all patients above 20 years of age who were registered in phases 1 and 4 of TLGS. Each phase had a 3-year duration. 4580 patients were recruited in each phase (916 patients in each age-group, including 3772 males and 5145 females). Random cluster sampling was used in phase 1 and convenience sampling was used in phase 4. Diabetes and glucose tolerance status were determined according to the 1991 criteria of the American Diabetes Association. In our five age groups, risk factors were compared, which included physical activity, waist circumference, body mass index, education, smoking, lipid profile and family history. Exclusion criteria were placement of an individual in the same age-group in the two phases and pregnancy. We calculated the prevalence of diabetes and dysglycemia in each age-group. Age-specific prevalence rates were determined. Prevalence of risk factors in the two phases were compared using chi-square test and Student t-test. Mann-Whitney U test was used to analyze the variables with non-normal distribution. RESULTS: In this study, 3976 individuals were recruited in phase 1 (2308 women and 1668 men; female to male ratio 1.38) and 4941 individuals were recruited in phase 4 (2837 women and 2104 men; female to male ratio 1.35). Prevalence of prediabetes in all age groups (except for the 30-39 years age-group) were increased in phase 4 compared to phase 1. Prevalence of known diabetes in all age groups were increased in phase 4 compared to phase 1, yet, the increase was significant only in the 30-39 and 60-69 years age groups (1.8% vs. 0.7% and 19.0% vs. 10.2%, respectively). Newly diagnosed diabetes was decreased in all age groups in phase 4, except for the 60-69 years age-group. The incidence of newly diagnosed diabetes in the 60-69 years age-group was significantly higher in phase 4 compared to the similar age-group of phase 1 (15.2% vs. 11.8%; p<0.001). Physical activity, body mass index, waist circumference (central obesity), general obesity, smoking (except for the 30-39 and 40-49 years age groups), and level of education were significantly higher in phase 4 compared to phase 1. Marriage rates were significantly lower in phase 4 compared to phase 1 across all studied age groups. CONCLUSION: We observed an increasing trend in the prevalence of diabetes over a 10-year period in TLGS. This is an accordance with estimates ​​in this field and highlights the need for education, prevention, treatment and control of diabetes. We also found increased rates of central and general obesity, smoking and divorce along with decreased marriage rates, which should be considered by the healthcare policymakers and state health officials as significant risk factors of diabetes.

Prognostic significance of the complex "Visceral Adiposity Index" vs. simple anthropometric measures: Tehran lipid and glucose study.

BACKGROUND: Visceral adiposity index (VAI) has recently been suggested to be used as a surrogate of visceral adiposity. We examined if VAI could improve predictive performances for CVD of the Framingham's general CVD algorithm (a multivariate model incorporating established CVD risk factors). We compared the predictive abilities of the VAI with those of simple anthropometric measures i.e. BMI, waist-to-height ratio (WHtR) or waist-to-hip ratio (WHpR). DESIGN AND METHODS: In a nine-year population-based follow-up, 6,407 (2,778 men) participants, free of CVD at baseline, aged≥30 years were eligible for the current analysis. The risk of CVD was estimated by incorporating VAI, BMI, WHpR, and WHtR, one at a time, into multivariate accelerated failure time models. RESULTS: We documented 534 CVD events with the annual incidence rate (95%CIs) being 7.3 (6.4-8.3) among women and 13.0 (11.7-14.6) among men. Risk of future CVD increased with increasing levels of VAI among both men and women. VAI was associated with multivariate-adjusted increased risk of incident CVD among women. However, the magnitude of risk conferred by VAI was not significantly higher than those conferred by BMI, WHpR, or WHtR. Among men, after adjustment for established CVD risk factors, VAI was no longer associated with increased risk of CVD. VAI failed to add to the predictive ability of the Framingham general CVD algorithm. CONCLUSIONS: Using VAI instead of simple anthropometric measures may lead to loss of much information needed for predicting incident CVD.

Prevalence of metabolic syndrome by the Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions and their association with coronary heart disease in an elderly Iranian population

<p><b>INTRODUCTION</b>To determine the prevalence of the metabolic syndrome (MS) in an Iranian elderly population and show its association with coronary heart disease (CHD).</p><p><b>MATERIALS AND METHODS</b>This is a cross-sectional study on 720 Iranian men and women aged > or = 65 years who participated in the Tehran Lipid and Glucose Study (TLGS). Logistic regression analysis was used to estimate the odds ratio (OR) of developing CHD in model 1, an age-adjusted model; model 2, adjusted for age, smoking status, premature history of CHD and low-density lipoprotein (LDL) cholesterol; and model 3, adjusted for mentioned variables plus the MS components.</p><p><b>RESULTS</b>The prevalence of MS was 50.8%, 41.8% and 41.9% based on the Adult Treatment Panel (ATPIII), the World Health Organisation (WHO), and the International Diabetes Federation (IDF) definitions, respectively. The IDF definition showed high agreement with the ATPIII definition. Age-adjusted OR (95% CI) of the MS for CHD was 1.6 (1.2 to 2.2) by both the ATPIII and WHO definitions and 1.4 (1.0 to 1.9) by the IDF definition. IDF-defined MS lost its association with CHD in model 2. In model 3, obesity (WHO definition) and high blood pressure (ATPIII and WHO definitions) were associated with CHD.</p><p><b>CONCLUSIONS</b>In an elderly Iranian population MS is highly prevalent. ATPIII and WHO definitions seem to be more pertinent than IDF for screening CHD risk. None of these definitions showed association with CHD when considering their components.</p>