Kim CS, Suh SH, Choi HS, Bae EH, Ma SK, Kim B, Han KD, Kim SW. Impact of diabetes duration and hyperglycemia on the progression of diabetic kidney disease: Insights from the KNHANES 2019-2021. World J Diabetes 2025; 16(5): 102094 [DOI: 10.4239/wjd.v16.i5.102094]
Corresponding Author of This Article
Soo Wan Kim, MD, PhD, Professor, Department of Internal Medicine, Chonnam National University Medical School, Jebongro 42, Gwangju 61469, South Korea. skimw@chonnam.ac.kr
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. May 15, 2025; 16(5): 102094 Published online May 15, 2025. doi: 10.4239/wjd.v16.i5.102094
Impact of diabetes duration and hyperglycemia on the progression of diabetic kidney disease: Insights from the KNHANES 2019-2021
Chang Seong Kim, Sang Heon Suh, Hong Sang Choi, Eun Hui Bae, Seong Kwon Ma, Bongseong Kim, Kyung-Do Han, Soo Wan Kim
Chang Seong Kim, Sang Heon Suh, Hong Sang Choi, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim, Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea
Chang Seong Kim, Sang Heon Suh, Hong Sang Choi, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, South Korea
Bongseong Kim, Kyung-Do Han, Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, South Korea
Co-corresponding authors: Kyung-Do Han and Soo Wan Kim.
Author contributions: Han KD and Kim SW contribute equally to this study as co-corresponding authors; Kim CS, Han KD and Kim SW conceived and designed the study; Kim CS and Kim BS participated in drafting the manuscript and provided revision and final editing; all authors analyzed the data, and reviewed the manuscript; all authors contributed to the article and approved the submitted the manuscript.
Supported by the National Research Foundation (NRF) of Korea, No. RS-2023-00217317.
Institutional review board statement: The study was approved by the Institutional Review Board of Chonnam National University Hospital (CNUH-EXP-2024-205).
Informed consent statement: The requirement for written informed consent was waived by the review board due to using anonymous and de-identified information. The institutional review board of the Korean Centers for Disease Control approved the KNHANES.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data underlying this article will be shared on reasonable request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Soo Wan Kim, MD, PhD, Professor, Department of Internal Medicine, Chonnam National University Medical School, Jebongro 42, Gwangju 61469, South Korea. skimw@chonnam.ac.kr
Received: October 9, 2024 Revised: February 20, 2025 Accepted: March 14, 2025 Published online: May 15, 2025 Processing time: 198 Days and 21.3 Hours
Abstract
BACKGROUND
Diabetes is a significant risk factor for chronic kidney disease, and diabetic kidney disease (DKD) is prevalent among patients with diabetes. Previous studies have indicated that the duration of diabetes and poor glycemic control are associated with an increased risk of DKD, but data on how the duration and severity of hyperglycemia specifically relate to DKD progression are limited.
AIM
To investigate the relationship between diabetes duration and glycemic control, and DKD progression in South Korea.
METHODS
We included 2303 patients with diabetes using the 2019-2021 Korea National Health and Nutrition Examination Surveys data. DKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m2, urinary albumin-to-creatinine ratio ≥ 30 mg/g, or both. Diabetes duration and severity were classified into six categories each.
RESULTS
DKD prevalence was 25.5%. The DKD risk significantly increased in diabetes lasting 10-15 years or hemoglobin A1C (HbA1c) ≥ 8% compared to patients with newly diagnosed diabetes or HbA1c < 6.5%. Albuminuria developed with shorter diabetes duration and lower HbA1c than eGFR decline. The adjusted odds ratios for DKD were 3.77 [95% confidence interval (95%CI): 2.60-5.45] and 4.91 (95%CI: 2.80-8.63) in patients with diabetes lasting ≥ 20 years and HbA1c ≥ 10%, respectively, compared to those with new-onset diabetes and HgA1c < 6.5%.
CONCLUSION
Patients with diabetes lasting > 10 years or HbA1c > 8% had a higher risk of DKD, emphasizing the importance of early monitoring and management is crucial to prevent DKD progression.
Core Tip: This study reveals that approximately 25% of Korean adults with diabetes have diabetic kidney disease (DKD), with a significantly higher risk in patients with a diabetes duration of more than 10 years or a hemoglobin A1C (HbA1c) level above 8%. Albuminuria, an early marker of DKD, developed with shorter diabetes duration and lower HbA1c than the decline in estimated glomerular filtration rate. These findings highlight the need for vigilant kidney function monitoring in patients with long-standing diabetes or poor glycemic control.
