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Abstract: FR-PO190

Rural Disparities in Estimated Glomerular Filtration Rate Changes in Patients with and at-Risk of CKD

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • McPherson, Sterling, Washington State University College of Medicine, Spokane, Washington, United States
  • Williamson, Jenna, University of Washington, Spokane, Washington, United States
  • Daratha, Kenn B., Washington State University, Colbert, Washington, United States
  • Dieter, Brad, Providence Sacred Heart , Spokane, Washington, United States
  • Alicic, Radica Z., Providence Medical Research Center, Spokane, Washington, United States
  • Duru, Obidiugwu, David Geffen School of Medicine, Los Angeles, California, United States
  • Nicholas, Susanne B., UCLA Medical Center, Westchester, California, United States
  • Norris, Keith C., UCLA, Marina Del Rey, California, United States
  • Tuttle, Katherine R., University of Washington School of Medicine, Spokane, Washington, United States

Group or Team Name


Little is known about chronic kidney disease CKD progression among rural versus urban dwelling patients. The study aim was to determine associations of residential location with estimated glomerular filtration rate (eGFR) over time in patients with and at-risk for CKD.


Providence and UCLA healthcare systems collaboratively formed a CKD and at-risk CKD registry from electronic health records (n=3,118,853). Participants were identified by diagnosis of CKD, at-risk for CKD (diabetes, pre-diabetes, or hypertension) by ICD-9/10 codes and condition-specific criteria from 2006-2016. The primary outcome was eGFR (CKD-EPI-creatinine) including >3 values over >90 days, and the main covariate of interest was rural versus urban dwelling defined by Rural-Urban Commuting Area codes. Other pre-specified covariates in the random effects regression model included: age, gender, race; and time-varying covariates: HbA1c, systolic blood pressure, and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACE/ARB) usage.


Baseline characteristics: 59±17 years of age, 56% female, 10% rural dwelling, 86% White, 6% Black or African American, and 7% Asian. Baseline eGFR was 60.6±22.5 mL/min/1.73m2 in the CKD cohort and 90.0±18.3 mL/min/1.73m2in the at-risk cohort.For both the CKD and at-risk cohort, patients dwelling in a rural versus an urban location experienced a nearly 4 mL/min/1.73m2greater annual decline in eGFR (B = -3.81, 95% CI: -4.21 - -3.42, p<0.001) over a median of 5 years, controlling for other covariates. eGFR decline significantly varied across race and was inversely associated with age, time, and ACE/ARB usage. eGFR decline was positively associated with female sex and systolic blood pressure. HbA1c was not associated with eGFR change.


In patients with CKD and at-risk for CKD, rurality independently associated with faster loss of kidney function compared to urban dwelling. Facilitators and overcoming barriers to better care are needed for these patients in rural locations.


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