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Kidney Week

Abstract: SA-OR084

Risks of eGFR Decline Thresholds by CKD, Diabetes, and Albuminuria Status

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Daratha, Kenn B., Providence Health Care, Colbert, Washington, United States
  • Jones, Cami R., Providence St. Joseph Health, Spokane, Washington, United States
  • Tuttle, Katherine R., University of Washington School of Medicine, Spokane, Washington, United States
Background

Thresholds for estimated glomerular filtration rate (eGFR) decline are increasingly used as chronic kidney disease (CKD) outcomes and clinical trial endpoints. eGFR decline thresholds of 30%, 40%, and 50% predict end-stage kidney disease. However, data from large clinical populations to determine risks of reaching these thresholds among patients with and at-risk of CKD [diabetes mellitus (DM), pre-DM, and hypertension (HTN)] and by DM or albuminuria status among patients with CKD are lacking.

Methods

CURE-CKD is a meticulously curated registry of clinical and administrative data extracted from health records of two major healthcare systems in the western United States. eGFR (CKD-EPI) was calculated as the mean value during a 90-day baseline and for each subsequent year (2006-2017). Adults with baseline eGFR >15 mL/min/1.73m2 and at least two follow-up years were included. Albuminuria was defined as urine albumin-to-creatinine ratio ≥30 mg/g. Time-to-event models examined eGFR decline thresholds, controlling for age, gender, race/ethnicity, baseline eGFR, and medication use. An alpha of p<0.001 was chosen a-priori.

Results

A total of 1,005,986 patients with mean follow-up of 5.4 years were included (table 1). For patients with established CKD compared to those at-risk of CKD, adjusted hazard ratios (aHRs) for eGFR decline thresholds (30%, 40%, 50%) were increased (1.93, 2.05, 2.16). For patients with CKD, those with DM compared to without DM had increased aHR (1.57, 1.71, 1.75). For patients with CKD and DM, aHR were increased for those with albuminuria compared to without albuminuria (1.38, 1.41, 1.44). Among patients with CKD and no DM, aHR were increased for those with albuminuria compared to without albuminuria (1.81, 1.93, 1.97).

Conclusion

Patients with CKD had increased risk of reaching clinically relevant eGFR decline thresholds compared to patients at-risk with DM, pre-DM, or HTN. Among patients with CKD, DM or, albuminuria independently predicted thresholds of eGFR decline. Study findings inform the design of observational studies and clinical trials in patients with and at-risk of CKD.

Funding

  • Private Foundation Support