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Kidney Week

Abstract: PO0761

Changes in Kidney Disease: Improving Global Outcomes (KDIGO) Risk Categories in Patients with Type 2 Diabetes and CKD

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Pantalone, Kevin, Cleveland Clinic, Cleveland, Ohio, United States
  • Mullins, C. Daniel, University of Maryland Baltimore, Baltimore, Maryland, United States
  • Betts, Keith A., Analysis Group Inc, Los Angeles, California, United States
  • Song, Jinlin, Analysis Group Inc, Los Angeles, California, United States
  • Wu, Aozhou, Analysis Group Inc, Los Angeles, California, United States
  • Kong, Sheldon X., Bayer U.S. LLC, Whippany, New Jersey, United States
  • Singh, Rakesh, Bayer U.S. LLC, Whippany, New Jersey, United States
Background

UACR is an important measure of kidney damage, but it is under-utilized in clinical practice. To comprehensively characterize the course of CKD in patients with T2D and CKD, this study evaluated changes in KDIGO risk categories based on both eGFR and UACR.

Methods

A prevalent cohort of adult patients with T2D and both eGFR and UACR measures indicating CKD of moderate or high risk based on KDIGO risk categories were identified from the Optum electronic health records database (2007 - 2019). The index date was defined as the first record indicating CKD of moderate or high risk after T2D diagnosis. The proportion of patients moving to a higher risk category in 5 years was estimated using Kaplan-Meier analysis. Average eGFR and UACR were also calculated over time.

Results

The index risk categories among the 269,187 patients with T2D and CKD were 81% moderate risk and 19% high risk. The majority of high-risk patients with impaired eGFR moved to very high risk within 5 years (G2-A3: 72%; G3a-A2: 88%; G3b-A1: 87%). Patients with index moderate risk and impaired eGFR also had high risk of moving to a higher risk category (G2-A2: 54%; G3a-A1: 84%). (Table) Patients with comparable eGFR had faster eGFR decline if their UACR level was elevated. (Figure)

Conclusion

The majority of T2D patients with CKD of moderate or high risk moved to a higher risk category within 5 years, even with mildly decreased eGFR. Those with more impaired UACR had faster decline in eGFR, which confirms the value of UACR in CKD management.

Table. Changes in KDIGO risk categories in 5 years
 Moderate Risk at Index DateHigh Risk at Index Date
G1-A2
n=66,754
G2-A2
n=86,379
G3a-A1
n=65,558
G1-A3
n=6,085
G2-A3
n=8,989
G3a-A2
n=18,354
G3b-A1
n=17,068
Moved to high/very high risk (%)18.853.983.712.871.688.087.1
Moved to high risk (%)16.737.856.3
Moved to very high risk (%)2.116.127.412.871.688.087.1

Funding

  • Commercial Support