Abstract: TH-PO726

Mortality in Diabetic Adults with Low eGFR in the Absence of Increased Urine Albumin Excretion Is Increasing

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Kramer, Holly J., Loyola University Medical Center, Maywood, Illinois, United States
  • Boucher, R. E., University of Utah, Salt Lake City, Utah, United States
  • Wei, Guo, University of Utah, Salt Lake City, Utah, United States
  • Greene, Tom, University of Utah, Salt Lake City, Utah, United States
  • Leehey, David J., Loyola University Medical Center, Maywood, Illinois, United States
  • Fried, Linda F., VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
  • Rosas, Sylvia E., Joslin Diabetes Center, Boston, Massachusetts, United States
  • Beddhu, Srini, University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

Due to improvements in diabetes management, the prevalence of low estimated glomerular filtration rate (eGFR) has increased while prevalence of increased urine albumin excretion (albumin-to-creatinine ratio [ACR] ≥ 30 mg/g) has decreased. These trends may influence mortality due to the heterogeneity of risk across chronic kidney disease (CKD) phenotypes.

Methods

We used data from the National Health and Nutrition Examination Surveys 1988-2006 linked with the National Death Index through December 31, 2011 to examine temporal trends in mortality and total number of deaths by CKD phenotype in the U.S. diabetic population by CKD phenotype. Diabetes was defined as presence of a fasting glucose ≥ 126 mg/dl, hemoglobin A1c > 6.5% or use of glucose lowering medications. The analyses accounted for the complex survey design.

Results

From 1988 to 2006, diabetic adults with low eGFR and ACR < 30 mg/g increased from approximately 0.9 (95% CI 0.7, 1.1) million during years 1988-1994 to 2.0 (95% CI 1.5, 2.6) million during years 2007-2010. During years 1988-2006, mortality rates generally trended downward for all groups with ACR ≥ 30 mg/g but increased in adults with low eGFR and ACR < 30 mg/g from 35 deaths per 1000 person-years (95% CI 22,55) during years 1988-1994 to 51 deaths per 1000 person-years (95% CI 33, 83) during years 2003-2006 (Figure). The proportion of deaths in the total U.S. population with diabetes occurring in the setting of low eGFR and ACR < 30 mg/g increased from 8.7% during years 1988-1994 to 21.9% during years 2003-2006. Findings did not change substantially after standardizing for the age distribution of the populations.

Conclusion

These findings demonstrate an urgent need to determine optimal management strategies to reduce mortality in diabetics with low eGFR in the absence of increased urine albumin excretion.

Funding

  • NIDDK Support