Association of cardiovascular risk factors with diabetic kidney disease severity in the Iranian population

Diabetic Kidney Disease (DKD), a serious complication of diabetes mellitus (DM), is a leading cause of end-stage renal disease and a significant contributor to cardiovascular morbidity. This study explores the association of cardiovascular disease (CVD) risk factors with severity of diabetic kidney disease in Iran. Utilizing data from the 2021 nationwide STEPwise approach to Noncommunicable Disease Risk Factor Surveillance (STEPS), this cross-sectional study included 3,272 diabetic adults aged ≥ 25 years. DKD was defined based on eGFR and albuminuria levels using KDIGO guideline. Key CVD risk factors were analyzed using multivariable ordinal logistic regression. Among the participants, 7.64% (6.73,8.55) and 20.3% (18.92,21.68) were at high/very high and moderately increased risk of DKD respectively. Older age [OR = 1.81 (1.19,2.74)], longer diabetes duration (> 10 years) [OR = 1.34(1.08,1.66)], uncontrolled glycemia (HbA1c ≥ 7) [OR = 1.57 (1.32,1.88)], dyslipidemia [OR = 1.49 (1.10,2.04)], systolic blood pressure  ≥  140 [OR = 1.42 (1.17,1.73)], and use of insulin [OR = 2.46 (1.60,3.78)] or multiple antihypertensive medications [OR = 2.11 (1.59,2.79)] were significantly associated with higher DKD risk. CVD risk factors, particularly hypertension, dyslipidemia, and poor glycemic control, have a strong association with severity of DKD. These findings underscore the need for early risk stratification and targeted interventions to delay renal deterioration in diabetic patients.