Use of antidiabetes and antihypertensive medications in T2DM by CKD stages*
| CKD stages (eGFR determined by CKD-EPI equation) | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Mild-to-moderate CKD | Moderate to kidney failure | ||||||||
| Overall | No CKD | Stage 1 | Stage 2 | Stage 3a | Stage 3b | Stage 4 | Stage 5 | ||
| 1380 | 1122 | 144 | 159 | 165 | 93 | 32 | 16 | ||
| NHANES sample, n | Projected National Prevalence, % (95% CI) | p Value* | |||||||
| Antidiabetes medication use | |||||||||
| Filled an antidiabetes medication | 83.1 (80.1 to 86.2) | 81.3 (77.7 to 84.9) | 83.7 (76.9 to 90.5) | 89.3 (83.3 to 95.3) | 84.4 (78.9 to 89.8) | 83.7 (74.2 to 93.3) | 93.6 (81.0 to 100.0) | 76.6 (46.6 to 100.0) | 0.0686 |
| Insulin | 18.9 (16.7 to 21.2) | 15.1 (11.8 to 18.3) | 16.2 (9.7 to 22.6) | 27.5 (17.3 to 37.7) | 24.9 (14.9 to 35.0) | 22.4 (10.1 to 34.8) | 38.2 (19.9 to 56.4) | 62.8 (28.5 to 97.1) | 0.0078 |
| Oral antidiabetes medication | 75.1 (71.8 to 78.3) | 75.4 (71.1 to 79.7) | 80.8 (73.5 to 88.1) | 76.9 (69.1 to 84.7) | 71.9 (62.5 to 81.3) | 71.5 (58.1 to 84.9) | 69.1 (51.6 to 86.7) | 43.7 (0.0 to 100.0) | 0.3802 |
| Biguanides | 55.6 (51.8 to 59.4) | 61.9 (56.2 to 67.6) | 68.1 (55.9 to 80.4) | 55.2 (44.2 to 66.1) | 40.3 (33.6 to 47.0) | 29.0 (21.3 to 36.7) | 3.5 (0.0 to 7.0) | 3.0 (0.0 to 6.9) | <0.0001 |
| Sulfonylureas | 35.4 (32.2 to 38.7) | 30.5 (26.6 to 34.4) | 43.6 (34.1 to 53.1) | 42.2 (35.3 to 49.2) | 36.2 (27.0 to 45.3) | 52.9 (40.0 to 65.8) | 55.6 (38.7 to 72.6) | 14.9 (0.0 to 33.8) | 0.0013 |
| Thiazolidinediones | 17.2 (14.6 to 19.7) | 17.1 (14.5 to 19.7) | 14.1 (5.6 to 22.6) | 19.2 (13.4 to 24.9) | 17.4 (8.5 to 26.2) | 19.7 (9.5 to 30.0) | 9.9 (0.0 to 26.2) | 25.7 (0.0 to 100.0) | 0.9908 |
| DPP-4 inhibitors | 7.4 (5.2 to 9.6) | 7.0 (3.9 to 10.2) | 4.4 (1.1 to 7.8) | 7.5 (1.4 to 13.7) | 6.4 (2.6 to 10.2) | 11.5 (3.5 to 19.5) | 22.9 (0.5 to 45.3) | 7.1 (0.0 to 16.0) | 0.2315 |
| Antidiabetes combinations | 7.3 (5.3 to 9.3) | 8.1 (4.9 to 11.4) | 9.3 (4.5 to 14.1) | 5.6 (2.2 to 9.0) | 6.2 (2.1 to 10.4) | 5.1 (0.0 to 11.3) | 0.0 (0.0 to 0.0) | 0.0 (0.0 to 0.0) | 0.1689 |
| Meglitinides | 2.0 (0.9 to 3.1) | 2.0 (0.7 to 3.2) | 0.3 (0.0 to 1.1) | 3.6 (1.8 to 5.5) | 2.1 (0.0 to 5.3) | 1.3 (1.0 to 1.6) | 4.6 (0.0 to 14.8) | 0.0 (0.0 to 0.0) | 0.9808 |
| Incretin mimetics | 1.8 (0.8 to 2.8) | 2.0 (0.1 to 3.8) | 2.7 (0.0 to 8.1) | 1.8 (0.0 to 4.5) | 1.7 (0.0 to 4.8) | 0.0 (0.0 to 0.0) | 0.0 (0.0 to 0.0) | 0.0 (0.0 to 0.0) | N/A |
| α-Glucosidase inhibitors | 0.8 (0.0 to 1.7) | 0.1 (0.0 to 0.3) | 0.4 (0.0 to 1.1) | 3.5 (0.0 to 10.0) | 0.8 (0.0 to 2.5) | 0.9 (0.0 to 2.8) | 6.2 (0.0 to 19.9) | 0.0 (0.0 to 0.0) | 0.2977 |
| Amylin analogs | 0.2 (0.0 to 0.5) | 0.1 (0.0 to 0.3) | 0.0 (0.0 to 0.0) | 1.4 (0.0 to 3.8) | 0.0 (0.0 to 0.0) | 0.0 (0.0 to 0.0) | 0.0 (0.0 to 0.0) | 0.0 (0.0 to 0.0) | N/A |
| Antihypertensive medication use | |||||||||
| Filled an antihypertensive medication | 75.7 (71.3 to 80.0) | 69.0 (63.4 to 74.5) | 63.4 (53.1 to 73.8) | 90.2 (86.2 to 94.1) | 89.5 (82.5 to 96.5) | 96.0 (91.9 to 100.0) | 100.0 (100.0 to 100.0) | 96.8 (92.7 to 100.0) | <0.0001 |
| ACE inhibitors | 40.2 (36.5 to 43.9) | 37.7 (33.2 to 42.3) | 42.9 (34.0 to 51.8) | 50.9 (42.2 to 59.7) | 40.3 (30.5 to 50.1) | 45.6 (29.0 to 62.2) | 28.3 (15.8 to 40.7) | 41.1 (0.0 to 100.0) | 0.0769 |
| β-Blockers | 30.6 (27.2 to 34.1) | 23.5 (19.3 to 27.8) | 15.4 (9.3 to 21.5) | 45.0 (35.3 to 54.6) | 40.7 (31.0 to 50.5) | 55.0 (42.2 to 67.9) | 75.9 (60.4 to 91.5) | 82.2 (59.8 to 100.0) | <0.0001 |
| Diuretics | 36.2 (32.4 to 39.9) | 29.5 (25.2 to 33.7) | 21.6 (12.8 to 30.5) | 42.1 (32.4 to 51.8) | 49.8 (38.7 to 60.9) | 72.0 (61.2 to 82.8) | 76.1 (56.7 to 95.5) | 33.9 (3.8 to 64.0) | <0.0001 |
| Thiazide diuretics | 23.7 (21.6 to 25.9) | 22.5 (19.0 to 26.1) | 18.3 (10.8 to 25.9) | 24.0 (15.8 to 32.2) | 27.2 (19.1 to 35.2) | 34.9 (27.5 to 42.4) | 33.4 (10.1 to 56.8) | 0.0 (0.0 to 0.0) | 0.1733 |
| Loop diuretics | 13.6 (11.5 to 15.7) | 7.0 (4.7 to 9.3) | 2.8 (0.0 to 5.9) | 21.4 (14.9 to 27.9) | 26.7 (18.6 to 34.9) | 38.9 (25.8 to 51.9) | 53.5 (39.8 to 67.3) | 33.9 (3.8 to 64.0) | <0.0001 |
| Potassium-sparing diuretics | 5.6 (3.9 to 7.4) | 6.1 (3.7 to 8.5) | 1.0 (0.0 to 3.0) | 3.5 (0.3 to 6.7) | 3.3 (0.7 to 5.9) | 13.8 (6.2 to 21.3) | 8.4 (0.0 to 21.0) | 8.6 (0.0 to 19.5) | 0.0079 |
| Angiotensin II inhibitors (ARBs) | 21.8 (18.4 to 25.1) | 19.4 (15.5 to 23.2) | 11.1 (5.3 to 16.9) | 25.3 (16.0 to 34.5) | 31.2 (22.1 to 40.3) | 32.6 (18.8 to 46.3) | 35.4 (18.5 to 52.2) | 16.1 (0.0 to 36.4) | 0.0513 |
| Calcium channel blockers | 19.7 (16.7 to 22.7) | 15.1 (11.3 to 18.9) | 12.6 (6.9 to 18.2) | 37.2 (29.5 to 44.9) | 23.9 (15.8 to 32.1) | 27.2 (16.6 to 37.8) | 32.6 (17.2 to 48.0) | 56.7 (0.0 to 100.0) | 0.0001 |
| Antihypertensive combinations | 17.9 (15.0 to 20.8) | 17.9 (14.4 to 21.4) | 9.8 (3.5 to 16.0) | 25.7 (15.7 to 35.7) | 16.4 (10.1 to 22.6) | 20.8 (7.3 to 34.3) | 13.8 (6.0 to 21.7) | 5.5 (0.0 to 12.4) | 0.9999 |
| Antiadrenergic agents—peripherally acting | 5.7 (4.0 to 7.4) | 3.9 (2.3 to 5.6) | 2.1 (0.0 to 4.2) | 8.6 (4.0 to 13.2) | 8.5 (3.1 to 14.0) | 13.5 (6.0 to 20.9) | 16.9 (0.0 to 39.5) | 6.0 (0.0 to 13.6) | 0.0319 |
| Vasodilators | 2.8 (1.8 to 3.7) | 1.6 (0.5 to 2.7) | 2.1 (0.0 to 4.2) | 3.4 (0.0 to 6.8) | 6.1 (1.1 to 11.0) | 6.7 (0.0 to 13.5) | 2.3 (0.0 to 4.5) | 21.2 (0.0 to 54.0) | 0.0405 |
| Antiadrenergic agents—centrally acting | 2.2 (0.9 to 3.5) | 0.3 (0.0 to 0.7) | 0.6 (0.0 to 1.7) | 8.0 (0.0 to 18.4) | 2.9 (0.7 to 5.0) | 7.3 (0.5 to 14.1) | 6.2 (0.0 to 14.2) | 23.4 (0.0 to 53.1) | 0.0100 |
Note: Medication use was analyzed using NHANES prescription survey data, not including self-reported use. Prescription data were not yet released in NHANES 2011–2012 survey cycle; therefore, only data from NHANES 2007–2008 and 2009–2010 survey cycles were used.
*Wald χ2 tests were used to compare medication use between patients with no CKD, mild-to-moderate CKD, and moderate CKD to kidney failure. p Value cannot be calculated if any of the table cell contains 0 expected frequency.
ARBs, angiotensin II receptor blockers; CKD, chronic kidney disease; CKD-EPI, the Chronic Kidney Disease Epidemiology Collaboration equation; DPP-4, dipeptidyl peptidase-4 inhibitor; eGFR, estimated glomerular filtration rate; T2DM, type 2 diabetes mellitus.