Abstract: SA-PO559
Predictors of CKD Progression, Mortality, and Cardiovascular Outcomes in Patients with and Without Diabetes
Session Information
- Diabetic Kidney Disease: Pathology, Epidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Olufade, Tope, AstraZeneca, Wilmington, Delaware, United States
- Lamerato, Lois, Henry Ford Health System, Detroit, Michigan, United States
- Jiang, Like, AstraZeneca, Wilmington, Delaware, United States
- Nolan, Stephen, AstraZeneca, Wilmington, Delaware, United States
- Israni, Rubeen K., AstraZeneca, Wilmington, Delaware, United States
Background
Diabetes and CKD are a growing burden for health systems, both in the US and internationally. Diabetes is thought to be responsible for approximately half of all end-stage renal disease (ESRD) cases. Also, the number of people with diabetes and CKD has increased dramatically along with the increase in diabetes itself. The role of albuminuria in CKD progression and cardiovascular (CV) outcomes is still underappreciated. This study examines CKD progression and CV outcomes in a contemporary real-world setting.
Methods
This retrospective cohort study used administrative data in Henry Ford Health System. eGFR lab results were used to identify patients with stage 2-4 CKD (index date) from 2006-2016 and followed through 2018. A second eGFR >90 days from index date excluded acute kidney injury. Patients with a history of renal transplant, death within 30 days of index date, or progression to ESRD within 6 months of index date were excluded. Logistic regression models were used to identify factors associated with ESRD and occurrence of a composite of myocardial infarction (MI), stroke, and all-cause mortality at 5 yrs of follow-up.
Results
The final cohort consisted of 29,303 patients. The population was 45% male, 38% African American (AA), 48% white, and had a mean age of 61 yrs. At baseline, 72% of patients had stage 2 CKD and 64% had type 2 diabetes (T2D). At 5 yrs of follow-up, ESRD occurred in 3.8%, heart failure (HF) in 17.6%, and the composite outcome in 17.5% (MI 5.8%, stroke 5.0%, all-cause mortality 9.4%). In the ESRD regression model, male gender, AA race, baseline eGFR, and diabetes were associated with high risk, and older age with lower risk. For the composite outcome, male gender, AA race, older age, T2D, and baseline eGFR were all associated with greater risk. In additional models examining the subset of patients with UACR (48% of patients), elevated UACR became the strongest predictor, with a 4-fold increased risk for both ESRD and the composite outcome.
Conclusion
There was a moderate risk of progression to ESRD, but a significant risk of the CV composite and HF outcomes over a 5-yr period. Traditional factors (eg, male gender, increasing age) were observed, but albuminuria was further identified as a strong independent risk factor.
Funding
- Commercial Support –