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Kidney Week

Abstract: PO0744

Post-Hospitalization Blood Pressure (BP) and Diabetes (DM) Control and Outcomes in Patients with Diabetic Kidney Disease (DKD)

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Golovey, Rimon, Montefiore Medical Center, Bronx, New York, United States
  • Navarro Torres, Mariela, Montefiore Medical Center, Bronx, New York, United States
  • Rikin, Sharon, Montefiore Medical Center, Bronx, New York, United States
  • Jariwala, Sunit, Montefiore Medical Center, Bronx, New York, United States
  • Golestaneh, Ladan, Montefiore Medical Center, Bronx, New York, United States

Group or Team Name

  • R Golovey, M Navarro-Torres share first author status
Background

DKD is the most common cause of ESKD in the US but because the course of progression is prolonged, research to elucidate risks and effective interventions are difficult.
In a high-risk cohort with DKD, do post-hospitalization BP and DM control act as good surrogate markers for outcomes?

Methods

Using Looking Glass, Montefiore Medical Center’s clinical database, we created a cohort of patients with a first discharge in 2016 who met the following criteria: CKD stage 3b or 4 and Proteinuria >300 and <5000mg/gm. Follow up data regarding CKD outcomes up to 2 years, clinic visits, RAASi prescriptions, mean systolic BP (SBP) and HgbA1c levels within 1 year of discharge were collected. Cox proportional hazards was used in adjusted analyses, to estimate the HR of mean SBP and HgbA1c levels, both dichotomized at the 75th percentile, with ESKD incidence or death over 2 years of follow-up.

Results

A total of 572 individuals met DKD criteria and had a first discharge in 2016. The mean age for the cohort was 66.8 years (SD 11.5), 244 (42.7%) were male, 224 (39.3%) were Black, 210 (36.8%) were Hispanic and 33 (5.8%) were White. Sixty-eight percent had a readmission within 1 year of discharge with median time to readmission at 63 days (IQR 22-184). Ninety-three percent of individuals had an outpatient clinic visit and the median number of clinic visits was 30 (IQR 16-47) over 1 year, with median time from discharge to an outpatient visit of 8 days (IQR 4-18). Mean SBP was 138mmHg (SD 22.2) with 26.9% of individuals with a mean SBP >150mmHg during 1 year of follow up. Mean HgbA1c was 8.6 (SD 2.1) with 192 (33.6%) who had HgbA1c >9.7 over 1 year of follow up. Eighty-eight (15.4%) patients died and 99 (17.3%) progressed to ESKD over 2 years of follow up. In models adjusting for age, sex and race/ethnicity there was a positive association between SBP >150 (HR 1.53, 95% CI: 1.12-2.09) and HgbA1c>9.7 (HR 1.58 95% CI: 1.16-2.15) and time to ESKD or death.

Conclusion

High mean BP and HgbA1c levels during 1 year post-discharge are associated with adverse outcomes in a cohort of hospitalized patients with DKD. These measures serve as useful surrogate biomarkers to study DKD interventions in a high-risk population.