Kidney Week

Abstract: FR-PO440

Rate of GFR Decline and Incident CKD among Primary Care Patients with Normal or Mildly Reduced Renal Function

Session Information

• CKD: Risk Factors for Incidence and Progression - II
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 301 CKD: Risk Factors for Incidence and Progression

Authors

• Koraishy, Farrukh M., Saint Louis University , Saint Louis, Missouri, United States

Farrukh M. Koraishy,

• Salas, Joanne, Saint Louis University , Saint Louis, Missouri, United States

Joanne Salas,

• Scherrer, Jeffrey F, Saint Louis University , Saint Louis, Missouri, United States

Jeffrey F Scherrer,

Background

Rapid GFR decline is associated with adverse outcomes. The risk factors associated with the rate of GFR decline in association with incident CKD among primary care patients with normal or mildly reduced GFR are not well defined.

Methods

From an academic primary care patient registry containing electronic health record data, we identified 2,219 adults with at least three eGFR values (calculated using the CKD-EPI equation) between July 1^st 2008 – June 30^th 2016. We required patients to have an initial (baseline) eGFR value between 60-119 ml/min/1.73 m². Rapid GFR decline was defined as a decline in eGFR of >5 ml/min/1.73 m²per year and incident CKD was defined as an eGFR of <60 ml/min/1.73 m². The clinical and socio-demographic characteristics were compared using chi-square tests and independent samples t-tests. Adjusted logistic regression models were computed to measure the associations between covariates among rapid decliners stratified by baseline eGFR of 60-89 (mildly reduced) and 90-119 (normal) ml/min/1.73 m².

Results

Rapid GFR decline was significantly associated with incident CKD, older age, black race, unmarried status, lower neighborhood socioeconomic status (nSES), hypertension, type 2 diabetes, current smoking and initial eGFR (p<0.01). Incident CKD was significantly associated with unmarried status (p =0.028), and type 2 diabetes (p<0.0001) in rapid decliners and with anxiety (p = 0.005)and depression (p = 0.5) in slow decliners. Older age, hypertension and initial GFR were significantly (p< 0.0001) associated with incident CKD in both groups. Multivariate logistic regression analysis restricted to patients with rapid GFR decline and mildly reduced baseline eGFR, revealed only older age being significantly associated with incident CKD (OR = 1.04 [1.01-1.08]). A separate multivariate logistic regression model among rapid decliners with a normal baseline eGFR revealed only type 2 diabetes being significantly associated with incident CKD (OR = 3.83 [1.35-10.89]).

Conclusion

Among primary care patients with normal or mildly reduced GFR (who are typically not referred to nephrology), patient characteristics associated with incident CKD differ by the rate of GFR decline and by the baseline eGFR. Our findings identify high-risk patients in primary care and would inform development of risk prediction models for incident CKD.

Funding

• NIDDK Support