Risk of Premature Death Among Individuals with Diabetes and Chronic Kidney Disease-Mineral and Bone Disorder in South Carolina

BACKGROUND: Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a complex condition involving kidney deterioration along with abnormal mineral and bone metabolism, with diabetics at a high risk for developing the condition, and women in particular with an increased risk of osteoporosis.  Treatments of CKD-MBD, such as active vitamin D sterol therapies, have been shown to delay the initiation of dialysis as well as reduce mortality, thus early screening for this disorder is essential to slow its progression.  The intention of this study was to enumerate the impact that CKD and CKD-MBD have on mortality among individuals with diabetes in South Carolina.

METHODS: Information used was from state-wide hospital discharge data from 2009-2011 in SC, including emergency room, inpatient and ambulatory surgery data on 306,327 identified individuals with diabetes. The dependent variable modeled was mortality.

RESULTS: After controlling for age, gender, race, urbanicity and source of payment, the odds of mortality among individuals with diabetes who had CKD was 5.75 times higher (95% CI: 5.55, 5.95) than that of those who did not have CKD, and 8.90 times higher (95% CI: 8.18, 9.67) for those with CKD-MBD than those without (p<.0001 for both groups).

CONCLUSIONS: Since individuals with diabetes are at a significantly higher risk of death after developing CKD or CKD-MBD, regular screening, detection and preventative treatment could reduce mortality associated with these disorders.  Diabetes care guidelines could be improved when they include provisions to address the CKD-MBD comorbid conditions.