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Kidney Week

Abstract: PO0439

CKD by Previous Diabetes or Hypertension: A Longitudinal Outcomes Study in Primary Care

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Vizcaya, David, Bayer Pharmaceuticals, Sant Joan Despí, Barcelona, Spain
  • Salvador-González, Betlem, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Cornella, Spain
  • Cunillera, Oriol, Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Cornella, Spain
  • Gil, Neus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Cornella, Spain
Background

To compare mortality and progression to end-stage-renal-disease (ESRD) in patients with new chronic kidney disease (CKD) by previous occurrence of type 2 diabetes (DM) and/or arterial hypertension (HT) in Catalonia

Methods

We designed a longitudinal retrospective study of adults with new CKD between 2007 and 2017 identified using electronic medical records from primary care in Catalonia, Spain. New CKD was considered the index event and defined as a first occurrence of an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2, a urine albumin-creatinine ratio ≥ 30 mg/g or albuminuria ≥ 20mcg for 90+ days, or a diagnostic code for CKD. Variables were extracted from the SIDIAP research database and the Spanish hospital basic minimum dataset. Patients were classified according to previous occurrence of DM, HT, both or none. The resulting mutually exclusive cohorts, DM-CKD, HT-CKD, DM/HT-CKD and unspec-CKD, were followed until ESRD and death within the study period. We defined ESRD as an eGFR<15 mL/min during 90+ days or renal replacement therapy. Fine and Grey regression models were used to assess differences in incidence of ESRD among the four CKD groups, considering mortality as a competing risk, and Cox regression for mortality. Both models were adjusted for multiple confounders

Results

In total, 467,802 persons were included (median age 75 years; 46.8% men]. At baseline, 51% had HT-CKD, 4% had DM-CKD, 33% had HT/DM-CKD and 12% had unspec-CKD. The DM-CKD group were the youngest in average, more likely to be men, had the highest proportion of persons with an eGFR below 60 mL/min/1.73m2 and the highest proportion of altered albuminuria. Compared to unspecific-CKD, DM- and HT-CKD had lower risk of ESRD -adjusted subdistribution hazard ratio (SHR) and 95% confidence interval (CI): 0.68 (0.54-0.84) and 0.71 (0.65-0.79), respectively, but HT/DM-CKD had a higher risk: SHR(CI) 1.11 (1.06-1.15). In turn, the risk for death was higher in DM-CKD, HR (CI): 1.19 (1.11-1.27) and lowest in the HT-CKD group, 0.84 (0.79-0.88), as compared to unspec-CKD. For the group HT/DM-CKD the HR(CI) was 0.92 (0.87-0.97)

Conclusion

According to these results, there are no differences in ESRD risk among CKD patients by prior DM or HT, but there is a synergistic effect. Mortality is different in CKD patients with HT vs with DM.

Funding

  • Commercial Support