Abstract: FR-PO670

Low Estimated Glomerular Filtration Rate (eGFR < 60 ml/min/1.73 m2) with Albumin-to-Creatinine Ratio [ACR)] <30 mg/g Is Associated with Increased Mortality Risk in Diabetics

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 School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, University of Utah, Salt Lake City, Utah, United States
  • Cheung, Alfred K., University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Cushman, William C., Memphis VA Medical Center, Memphis, Tennessee, United States
  • Beddhu, Srini, University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

Prevalence of low eGFR (< 60 ml/min/1.73 m2) with an ACR < 30 mg/g is increasing, especially among adults with diabetes, likely due to better management of chronic kidney disease (CKD) risk factors. Determining the association between CKD phenotypes including low eGFR with ACR < 30 mg/g in adults with and without diabetes may help guide prevention efforts to reduce CKD associated morbidity and mortality.

Methods

We examined unadjusted mortality rates by CKD phenotype (based on eGFR and ACR grouops) using data from the Action to Control Cardiovascular Disease (ACCORD), which included 9777 adults with diabetes, and the Systolic Blood Pressure Intervention trial (SPRINT), which included 8900 adults without diabetes. Cox proprortional hazards models were used to calculate the hazard ratio of mortality by CKD phenotype in these two study populations with simultaneous adjustment for demographics, blood pressure and prevalent cardiovascular disease with the eGFR ≥90 ml/min/1.73 m2 and ACR < 30 mg/g as referent group.

Results

The mean age was 62.8 (6.7) and 67.9 (9.4) years in ACCORD and SPRINT, respectively. In the ACCORD and SPRINT trials, mortality rates in the group with eGFR < 60 ml/min/1.73 m2 and ACR < 30 mg/g were 1.99 and 1.36 deaths per 100 person-years, respectively. After adjustment for covariates, presence of eGFR < 60 ml/min/1.73 m2 with ACR < 30 mg/g was associated with a 1.58-fold higher hazard rate for mortality (95% CI 1.19, 2.10) relative to eGFR ≥ 90 ml/min/1.73 m2 with ACR < 30 mg/g in ACCORD. No significant association was noted with this CKD phenotype and mortality in SPRINT (hazard ratio 1.17; 95% CI 0.76, 1.80) (see Figure).

Conclusion

Low eGFR with ACR < 30 mg/g is associated with increased mortality risk in adults with diabetes. These data demonstrate the need to identify and implement interventions that reduce mortality in adults with diabetes and CKD, including those without albuminuria.

Hazard ratios for mortality by CKD phenotypes in ACCORD (panel A) and SPRINT (panel B)

Funding

  • NIDDK Support