Kidney Week

Abstract: TH-PO1044

Disparities in CKD Progression Across Racial Groups in Two Large Health Systems

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

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

Authors

• Nicholas, Susanne B., David Geffen School of Medicine at UCLA, Los Angeles, California, United States

Susanne B. Nicholas,

• Daratha, Kenn B., Washington State University, Colbert, Washington, United States

Kenn B. Daratha,

• Shen, Jenny I., LaBiomed at Harbor-UCLA, Torrance, California, United States

Jenny I. Shen,

• Jones, Cami R., Providence St. Joseph Health, Spokane, Washington, United States

Cami R. Jones,

• Duru, Obidiugwu, David Geffen School of Medicine at UCLA, Los Angeles, California, United States

Obidiugwu Duru,

• McPherson, Sterling, Washington State University College of Medicine, Spokane, Washington, United States

Sterling McPherson,

• Alicic, Radica Z., Providence St. Joseph Health, Spokane, Washington, United States

Radica Z. Alicic,

• Tuttle, Katherine R., University of Washington School of Medicine, Spokane, Washington, United States

Katherine R. Tuttle,

• Norris, Keith C., David Geffen School of Medicine at UCLA, Los Angeles, California, United States

Keith C. Norris,

Group or Team Name

• CURE CKD

Background

Disparities exist in progression of chronic kidney disease (CKD) across racially diverse groups. The University of California, Los Angeles Health (UCLA) and Providence St. Joseph Health (PSJH) systems formed a CKD and At-risk CKD Data Registry to inform advances in population health, individual behaviors, social and physical environment, and precision medicine.

Methods

CKD progression was determined across self-reported racial/ethnic groups in the database (>3.1 million patients) that was populated from electronic health records of adults treated at UCLA and PSJH from 2006 to 2016. Eligibility in the Registry was based on identification of CKD, and at-risk for CKD defined by hypertension, diabetes, or pre-diabetes. Linear regression coefficients for individual trajectories were calculated for patients having at least 3 eGFRs (CKD-EPI-creatinine). Individuals were classified by change in eGFR over time. Linear mixed models were used to assess racial differences in eGFR trajectories, controlling for age, gender, and time-varying measurements of systolic blood pressure, hemoglobin A1C, and renin angiotensin system inhibitor use.

Results

Patients with statistically significant eGFR decline (≥2-3 mL/min/1.73m²/year; n=182,959, 16%) had a baseline of 79±26 mL/min/1.73m² (mean±SD) versus 81±23 mL/min/1.73m² in non-decliners (n=980,022, 84%). Non-White were more likely than White patients to experience eGFR decline after adjustment for relevant covariates in multi-variable models. Mortality rate for patients with significant eGFR decline was >3 times higher than in patients without eGFR decline.

Conclusion

In this large data registry from electronic health records at UCLA and PSJH, after multi-variable adjustment Non-White patients with CKD or at-risk for CKD are more likely to experience eGFR decline, which was associated with higher risk of mortality. Future directions include assessing eGFR decline by race/ethnicity and mortality risk in our unique cohort.

Funding

• Private Foundation Support