Age-related Associations of Hypertension and Diabetes Mellitus with Chronic Kidney Disease

Tareq M Islam; Caroline S Fox; Devin Mann; Paul Muntner


BMC Nephrology 

In This Article


Background: Studies suggest end-stage renal disease incidence and all-cause mortality rates among patients with chronic kidney disease (CKD) differ by age. The association of diabetes mellitus and hypertension with CKD across the adult lifespan is not well established.
Methods: Data from NHANES 1999–2004 were used to determine the association of risk factors for stage 3 or 4 CKD (n = 12,518) and albuminuria (n = 12,778) by age grouping (20 to 49, 50 to 69, and ≥70 years). Stage 3 or 4 CKD was defined as an estimated glomerular filtration rate of 15 to 59 ml/min/1.73 m2 and albuminuria as an albumin to creatinine ratio ≥30 mg/g.
Results: For adults 20 to 49, 50 to 69 and ≥70 years of age, the prevalence ratios (95% confidence interval) of stage 3 or 4 CKD associated with hypertension were 1.94 (0.86 – 4.35), 1.51 (1.09 – 2.07), 1.31 (1.15 – 1.49), respectively (p-trend = 0.038). The analogous prevalence ratios (95% confidence interval) were 3.01 (1.35 – 6.74), 1.61 (1.15 – 2.25), 1.40 (1.15 – 1.69), respectively, for diagnosed diabetes mellitus (p-trend = 0.067); and 2.67 (0.53 – 13.4), 1.35 (0.69 – 2.63), 1.08 (0.78 – 1.51), respectively, for undiagnosed diabetes mellitus (p-trend = 0.369). The prevalence ratios of albuminuria associated with hypertension and diagnosed and undiagnosed diabetes mellitus were lower at older age (each p < 0.05).
Conclusion: Among US adults, diabetes mellitus and hypertension are associated with CKD and albuminuria regardless of age. However, the associations were stronger at younger ages.


Chronic kidney disease (CKD), defined by the presence of albuminuria or reduced glomerular filtration rate (GFR), is common, and increasing, among adults in the United States and worldwide.[1–3] The incidence and prevalence of CKD increase markedly at older age.[2,4] For example, in the Framingham Heart Study, the risk of developing stage 3 CKD was 2.36 times higher for each 10 years older age.[4] Additionally, the prevalence of stage 1 or 2 and stage 3 or 4 CKD among US adults has been reported to be 3.3 and 54 times higher, respectively, for adults ≥70 versus 20 to 39 years of age.[2]

Although the incidence and prevalence of CKD increases with age, several reports have suggested that the relative risk of adverse outcomes including end-stage renal disease (ESRD) and mortality associated with CKD are attenuated at older age.[5,6] While these studies have provided important insight on outcomes among patients with established CKD, few data are available on the importance and differential impact of risk factors for CKD across the full adult lifespan. Similar to the age-related association of CKD with ESRD and mortality, the relationship between CKD and major risk factors may differ by age. To determine the association of risk factors for stage 3 or 4 CKD and albuminuria by age grouping, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004. We hypothesized that hypertension and diabetes mellitus are important risk factors for CKD regardless of age but, similar to patterns observed for outcomes among adults with CKD, these associations would be stronger for younger adults.