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Abstract: PO0972

The Effect of Microalbuminuria on Long-Term Outcomes in Elderly Patients with Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Hwang, Subin, Inje University Seoul Paik Hospital, Jung-gu, Seoul, Korea (the Republic of)
  • Lee, Kyungho, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
  • Kim, Do Hee, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
  • Jang, Hye Ryoun, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
  • Huh, Wooseong, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
  • Kim, Yoon-Goo, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
  • Kim, Dae joong, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
  • Lee, Jung eun, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)
Background

In current aging society, the number of elderly diabetes is rapidly growing worldwide. Despite strong evidence on the prognostic power of microalbuminuria in patients with diabetes, it remains uncertain that moderately increased urinary albumin excretion can identify elderly diabetes at high risk of ESRD (end stage renal disease) or mortality. This longitudinal study evaluated incidence of ESRD and mortality according to albuminuria amounts focusing on elderly diabetes.

Methods

We retrospectively identified 3,065 elderly (aged ≥65 years) diabetes. The primary outcomes were incidence of ESRD (considering competing risk with death) and all-cause death. The association between albuminuria (normoalbuminuria, urine albumin to creatinine ratio [uACR] <30mg/g, microalbuminuria, uACR 30-300mg/g, and macroalbuminuria, uACR >300mg/g) and outcomes focusing on elderly (≥65 years) and very elderly (≥75 years) with diabetes were evaluated.

Results

The age was 71.1 (5.0) years and the duration of diabetes was 13.4 (8.7) years. Median follow-up duration was 89 (19.6) months. Overall, microalbuminuria and macroalbuminuria were observed in 25.5% and 9.4% of subjects, respectively. For normoalbuminuria, microalbuminuria, and macroalbuminuria, probability of ESRD and cumulative all-cause death at 8 years was 1.0%, 6.3%, and 29.7% (P<.0001), and 13.1%, 27.4%, and 31.7% (P<.0001), respectively. Using proportional-hazards regression models, albuminuria amounts were independently associated with increased risk of ESRD (fully adjusted hazard ratios [HR] including kidney function: 3.92 [1.29-6.70] for microalbuminuria, 11.16 [6.47-19.24] for macroalbuminuria). The HR of all-cause death were 1.46 (1.21-1.76) for microabuminuria and 1.42 (1.08-1.86) for macroalbuminuria. The associations between albuminuria amounts and the risk of ESRD and all-cause death were consistent in very elderly (≥75 years).

Conclusion

We demonstrated that microalbuminuria is a risk factor of incident ESRD and death even in elderly diabetes, as well as in very elderly. Further studies are needed to determine whether albuminuria can be a therapeutic target in this population.