Abstract: TH-PO995
Disparities in Etiologic Classification of CKD
Session Information
- CKD Epidemiology, Risk Factors, Prevention - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Silverberg, Benjamin, University of Virginia, Charlottesville, Virginia, United States
- Yu, Wei, University of Virginia, Charlottesville, Virginia, United States
- Heng, Fei, University of North Florida, Jacksonville, Florida, United States
- Ahsan, Omar Julian, University of Virginia, Charlottesville, Virginia, United States
- Kelley, Alan Taylor, University of Utah Health, Salt Lake City, Utah, United States
- Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
- Scialla, Julia J., University of Virginia, Charlottesville, Virginia, United States
- Yan, Guofen, University of Virginia, Charlottesville, Virginia, United States
Background
Understanding the etiology of CKD is critical for targeted therapy. No prior study has evaluated disparities in assigning an etiology for CKD in practice. Due to widely described health disparities in CKD, we hypothesized that etiologic assignment would be lower for patients of Black race, Hispanic ethnicity, and female sex.
Methods
We identified adults in the Veterans Health Administration who had incident CKD stage G3 or higher (G3+) from 2005-2015. Incident CKD G3+ was defined as the first occurrence of two eGFRs <60 ml/min/1.73m2 >90 days apart. Patients with ICD-9/ICD-10 codes for general CKD (i.e., 585.X; N18.X) before the index date were excluded. Using 290 specific ICD-9/ICD-10 codes (e.g., N03.3) classified in 6 etiologic domains (diabetic, hypertensive/vascular, obstructive/urologic, glomerular, cystic/congenital, tubulointerstitial), we identified specific etiologic diagnoses of CKD within 3 yrs before or after incident CKD G3+. Logistic regression was used to evaluate disparities in assignment of a specific etiologic code by race/ethnicity and sex, stratified by age. We adjusted for geographic region, year of incident CKD, and comorbidities.
Results
Out of 452,851 patients (438,414 male/14,437 female), 42.5% received an etiologic assignment. Contrary to our hypothesis, rates of etiologic assignment among patients of non-Hispanic Black race or Hispanic ethnicity were higher compared to non-Hispanic White race/ethnicity. We found consistently lower rates of etiologic assignment among females compared to males in all age groups (Table).
Conclusion
Efforts are needed to improve the assignment of etiology of CKD, particularly among female Veterans. More work is needed to evaluate rates of specific etiologies and their accuracy in CKD.
Table. Adjusted odds ratios (95% confidence intervals) of etiologic assignment within 3 years before or 3 years after incident CKD
| Overall | Age group 18-44 | Age group 45-64 | Age group 65-74 | Age group 75 and above | |
| Female vs Male | 0.47 (0.45-0.48) | 0.51 (0.40-0.64) | 0.43 (0.41-0.45) | 0.49 (0.45-0.53) | 0.53 (0.48-0.58) |
| Asian, Native Hawaiian/Pacific Islander vs White | 1.09 (1.03-1.15) | 1.54 (0.72-3.27) | 1.12 (1.01-1.25) | 1.07 (0.96-1.18) | 1.04 (0.94-1.15) |
| Black vs White | 1.56 (1.53-1.59) | 1.59 (1.27-1.99) | 1.70 (1.65-1.76) | 1.51 (1.46-1.56) | 1.39 (1.34-1.44) |
| Hispanic vs White | 1.17 (1.13-1.21) | 1.76 (1.12-2.74) | 1.33 (1.25-1.41) | 1.15 (1.08-1.22) | 1.02 (0.96-1.09) |
| American Indian/Alaska Native vs. White | 1.11 (1.01-1.22) | 1.68 (0.44-6.42) | 1.09 (0.93-1.27) | 1.14 (0.98-1.33) | 1.10 (0.91-1.33) |
| Multiple or other races vs. White | 1.04 (0.98-1.09) | 0.85 (0.46-1.55) | 1.09 (1.00-1.19) | 1.05 (0.96-1.14) | 0.97 (0.88-1.07) |
Funding
- NIDDK Support