Social risk profiles and diabetic kidney disease: prevalence and mortality in US adults

Diabetic kidney disease (DKD) is a severe and prevalent complication of diabetes. Social contexts have been increasingly recognized as critical factors in the escalation and ongoing management of chronic diseases, including DKD. This study aimed to evaluate the connection between social risk profile (SRP) and DKD in United States.  METHODS: Data were sourced from the National Health and Nutrition Examination Survey (1999-2018). DKD was defined as the coexistence of diabetes and chronic kidney disease (CKD). SRP scores, based on the number of positive measures, were categorized into four quartiles: low (0-2), lower-middle (3-4), upper-middle (5-6), and high (7-8). The associations of SRP with the prevalence and mortality of DKD were assessed.  RESULTS: A total of 6,464 participants were included in the study, among them, 2,668 had DKD, and 1,153 died during a mean follow-up of 143 months. SRP scores were associated with the prevalence and mortality of DKD. Compared with high SRP scores, low SRP levels were related with a higher risk of DKD (OR, 1.86; 95% CI, 1.54 to 2.26, P < 0.0001). Higher SRP scores were associated with lower risks of mortality, including all-cause (HR, 0.84; 95% CI, 0.81-0.88; P < 0.0001), cardiovascular disease (HR, 0.85; 95% CI, 0.80-0.91; P < 0.0001), and diabetes-related mortality (HR, 0.86; 95% CI, 0.76-0.96; P = 0.009).  CONCLUSION: Lower SRP scores showed a connection to higher DKD prevalence and worse outcomes, highlighting the potential importance of social risk screening and targeted interventions.