ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO0517

Disparities in CKD Progression by Medicare Advantage Enrollees

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Diamantidis, Clarissa Jonas, Duke University School of Medicine, Durham, North Carolina, United States
  • Zepel, Lindsay, Duke University School of Medicine, Durham, North Carolina, United States
  • Wang, Virginia, Duke University School of Medicine, Durham, North Carolina, United States
  • Smith, Valerie A., Duke University School of Medicine, Durham, North Carolina, United States
  • Scholle, Sarah Hudson, National Committee for Quality Assurance, Washington, District of Columbia, United States
  • Tamayo, Loida A., Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
  • Maciejewski, Matthew L., Duke University School of Medicine, Durham, North Carolina, United States
Background

The prevalence of chronic kidney disease (CKD) in Medicare beneficiaries has quadrupled in the past two decades,but little is known about risk factors affecting the progression of CKD. This abstract aims to understand the progression of CKD up to five years after study entry in a large cohort of Medicare Advantage (MA) enrollees and whether it differs by provider recognition of CKD, race and ethnicity, or geographic location.

Methods

In a cohort of 1,002,388 MA enrollees with CKD stages 1-4 based on 2013-2018 labs, progression was estimated using a mixed-effects model that adjusted for demographics, urbanicity, comorbidity, urine albumin-to-creatinine ratio, clinical recognition via diagnosed CKD, and time fixed effects. Race and ethnicity, geographic location, or clinical recognition of CKD were interacted with time in three separate regression models.

Results

Mean (median) follow-up was 3.1 (3.0) years. At study entry, Black and Hispanic MA enrollees had greater kidney function at study entry than other beneficiaries, but their kidney function declined faster compared to non-Hispanic Whites. At study entry, MA enrollees with clinically recognized CKD had estimated glomerular filtration rate levels that were 18.6 units (95% confidence interval (CI): 18.5-18.7) lower than levels of unrecognized patients, but kidney function declined more slowly in enrollees with clinical recognition of CKD. There were no differences in CKD progression by metropolitan or non-metropolitan areas.

Conclusion

These results suggest that patients with clinically recognized CKD and racial and ethnic minorities merit closer surveillance and management to reduce their risk of faster progression.

Funding

  • Other U.S. Government Support