Diabetes Metab J.  2024 May;48(3):463-472. 10.4093/dmj.2023.0310.

2023 Diabetic Kidney Disease Fact Sheet in Korea

• Kim NH
• Seo MH
• Jung JH
• Han KD
• Kim MK
• Kim NH
• on Behalf of Diabetic Kidney Disease Research Group of the Korean Diabetes Association

• KMID: 2555777
• DOI: http://doi.org/10.4093/dmj.2023.0310

Abstract

Background
To investigate the prevalence, incidence, comorbidities, and management status of diabetic kidney disease (DKD) and diabetes-related end-stage kidney disease (ESKD) in South Korea.
Methods
We used the Korea National Health and Nutrition Examination Survey data (2019 to 2021, n=2,665) for the evaluation of prevalence, comorbidities, control rate of glycemia and comorbidities in DKD, and the Korean Health Insurance Service-customized database (2008 to 2019, n=3,950,857) for the evaluation of trends in the incidence and prevalence rate of diabetes-related ESKD, renin-angiotensin system (RAS) blockers and sodium glucose cotransporter 2 (SGLT2) inhibitors use for DKD, and the risk of atherosclerotic cardiovascular disease (ASCVD) and mortality according to DKD stages. DKD was defined as albuminuria or low estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² in patients with diabetes mellitus.
Results
The prevalence of DKD was 25.4% (albuminuria, 22.0%; low eGFR, 6.73%) in patients with diabetes mellitus aged ≥30 years. Patients with DKD had a higher rate of comorbidities, including hypertension, dyslipidemia, and central obesity; however, their control rates were lower than those without DKD. Prescription rate of SGLT2 inhibitors with reduced eGFR increased steadily, reaching 5.94% in 2019. Approximately 70% of DKD patients were treated with RAS blockers. The prevalence rate of diabetesrelated ESKD has been steadily increasing, with a higher rate in older adults. ASCVD and mortality were significantly associated with an in increase in DKD stage.
Conclusion
DKD is prevalent among Korean patients with diabetes and is an independent risk factor for cardiovascular morbidity and mortality, which requiring intensive management of diabetes and comorbidities. The prevalence of diabetes-related ESKD has been increasing, especially in the older adults, during past decade.

Keyword

Cardiovascular diseases; Diabetic nephropathies; Epidemiology; Incidence; Prevalence

Figure

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  Fig. 1. Prevalence of diabetic kidney disease (DKD) in South Korea-Korea National Health and Nutrition Examination Survey database 2019 to 2021. (A) Prevalence of DKD (aged ≥30 years). (B) Proportion of DKD with and without albuminuria. (C) Prevalence of DKD by age groups. (D) Distribution of age in DKD.

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  Fig. 2. Prevalence and control rate of comorbidities in patients with and without diabetic kidney disease (DKD)-Korea National Health and Nutrition Examination Survey database 2019 to 2021. (A) Prevalence of comorbidities in patients with and without DKD. (B) Optimal control rate of hyperglycemia and comorbidities in patients with and without DKD. Comprehensive control rate (1) indicates the proportion of patients whose glycosylated hemoglobin (HbA1c) <6.5%, blood pressure (BP) <130/80 mm Hg, and low-density lipoprotein-cholesterol (LDL-C) <70 mg/dL. Comprehensive control rate (2) indicates the proportion of patients whose HbA1c <7.0%, BP <140/90 mm Hg, and LDL-C <100 mg/dL.

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  Fig. 3. Trends in the prevalence and incidence rate of diabetes-related end-stage kidney disease (ESKD)-National Health Insurance Service (NHIS) database 2008 to 2019. (A) Age, and sex-standardized prevalence and incidence rate of diabetes-related ESKD. (B) Prevalence rate of diabetes-related ESKD by age group. (C) Incidence rate of diabetes-related ESKD by age group.

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  Fig. 4. Prescription rates of (A) sodium glucose cotransporter 2 inhibitors and (B) renin-angiotensin system blockers in diabetic kidney disease National Health Insurance Service database 2014 to 2019. DKD, diabetic kidney disease.

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