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Abstract: TH-PO419

eGFR Decline in Patients with CKD and at Risk for CKD by Age, Gender, and Race/Ethnicity in Two Large Health Systems

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Nicholas, Susanne B., David Geffen School of Medicine, Los Angeles, California, United States
  • Li, Ning, David Geffen School of Medicine, Los Angeles, California, United States
  • Daratha, Kenn B., Providence St. Joseph Health, Spokane, Washington, United States
  • Duru, Obidiugwu, David Geffen School of Medicine, Los Angeles, California, United States
  • Jones, Cami R., Providence St. Joseph Health, Spokane, Washington, United States
  • Shen, Jenny I., LaBiomed at Harbor-UCLA, Torrance, California, United States
  • Alicic, Radica Z., Providence St. Joseph Health, Spokane, Washington, United States
  • McPherson, Sterling, Providence St. Joseph Health, Spokane, Washington, United States
  • Tuttle, Katherine R., Providence St. Joseph Health, Spokane, Washington, United States
  • Norris, Keith C., David Geffen School of Medicine, Los Angeles, California, United States

Group or Team Name

  • CURE-CKD Registry Study Team
Background

Comparisons in eGFR decline in patients with CKD and At-risk for CKD have not been described. We completed an analysis of eGFR trajectories (eGFR-T) in CKD and At-risk for CKD patients from the UCLA-PSJH CKD Registry.

Methods

The cohort: >2.6 million adults (2006-2017) based on labs and/or diagnoses of CKD, hypertension (HTN), diabetes mellitus (DM), or pre-DM from administrative codes. We analyzed CKD (N=84,150) and At-risk CKD (N=807,211) patients with ≥3 eGFRs ≥15ml/min/1.73m2 followed for an average (SD) of 5.4±2.4years. We identified non-decliners, moderate and severe decliners (<2mL; 2-5mL and >5mL/min/1.73m2/year), by least-squares fit for individual eGFR-T. Linear mixed effects (LME) models compared eGFR-T in moderate and severe decliners across gender and race/ethnicity groups, stratified by CKD vs. At-risk for CKD.

Results

Most patients were 45-64 yrs (41%), female (56%) and White Non-Latino (83%). CKD vs. At-risk CKD patients were ≥65years (72% vs 36%), and had more DM (18% vs 106%) and HTN (25% vs 18%), p<0.001. Severe (vs. non- and moderate-) decliners had higher baseline eGFR and 27% of At-risk CKD progressed to eGFR <60ml/min/1.73m2). eGFR-T were steepest for CKD 18-44 yrs: -5.22 (95%CI= -5.38, -5.11) and At-risk patients 18-44 yrs: -4.16 (95% C= -4.18, -4.14) vs. other age groups, p<0.001. In LME bivariate analyses, eGFR slopes differed by age, gender and race/ethnicity for all decliners. Specifically, annual change in eGFR was lowest in patients >45 yrs (p<0.001) and declined in female>male CKD (p=0.025) and At-risk CKD (p<0.001) patients. eGFR-T were steepest for CKD American Indian/Alaska Native (p=0.007) and At-risk Native Hawaiian/Pacific Islander (p<0.001) vs. White Non-Latino. Similar results were obtained in fully adjusted LME models.

Conclusion

Patients with CKD are older, have more DM and HTN, lower baseline eGFR and more rapid renal function decline compared to At-risk CKD patients. CKD and At-risk CKD severe decliners were youngest, with the highest baseline eGFR. The study results suggest a subset of young patients with high baseline eGFR may be important to target to prevent rapid renal function decline.

Funding

  • Private Foundation Support