Kidney Week

Abstract: TH-PO441

Screening and Management of Albuminuria in a Large Integrated Health System

Session Information

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

Category: Hypertension and CVD

• 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

• Zafar, Waleed, Geisinger, Dnville, Pennsylvania, United States

Waleed Zafar,

• Green, Jamie Alton, Geisinger Medical Center, Danville, Pennsylvania, United States

Jamie Alton Green,

• Bucaloiu, Ion D., Geisinger Medical Center, Danville, Pennsylvania, United States

Ion D. Bucaloiu,

• Chang, Alex R., Geisinger Medical Center, Danville, Pennsylvania, United States

Alex R. Chang,

Background

Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend albuminuria screening in patients with hypertension or diabetes for appropriate risk stratification. Little is known about factors associated with adherence to KDIGO-recommended treatment goals for patients with albuminuria.

Methods

We used data from 212,068 adults ≥ 18 years of age with eGFR ≥ 15 ml/min/1.73m², who were seen by a primary care provider between 2015-2016 in a large, integrated health system. Patients were categorized as having severely increased albuminuria per KDIGO guidelines (ACR 300+ mg/g, PCR 500+ mg/g, or urine dipstick 1+), using quantitative tests if available. We then examined associations between sociodemographic and clinical factors with attainment of KDIGO-recommended goals [renin-angiotensin-aldosterone system (RAAS) inhibition, blood pressure (BP) goal <130/80, and statin treatment] in patients with severely increased albuminuria.

Results

Mean age was 55.2 years, 55.7% were female, 19% were current smokers, and 13.0% had baseline eGFR < 60 ml/min/1.73m². Among 87193 patients with hypertension, 70.5% were screened using any method, 41.3% were screened with ACR or PCR, and 9.9% had severely increased albuminuria. Among 33655 patients with diabetes, 91.3% were screened using any method, 82.9% were screened with ACR or PCR, and 10.4% had severely increased albuminuria. Of the 22153 patients with 1+ or greater protein on dipstick, only 40.2% also completed an ACR or PCR. Adherence to KDIGO-recommended goals was low in severely albuminuric patients (30.8% taking RAAS inhibitors, 33.8% taking statins, 48.2% with clinic BP <130/80); only 7.8% achieved all 3 goals. Factors associated with attainment of all 3 KDIGO-recommended goals in severely albuminuric patients included older age, cardiovascular risk factors, cardiovascular disease, and quantitative protein testing (Table). CKD was not associated with attainment of these goals.

Conclusion

Adherence to KDIGO guidelines for albuminuria remains suboptimal. Future research is needed to improve screening and management of albuminuria.

Funding

• NIDDK Support