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Kidney Week

Abstract: SA-PO477

Discrepancy Between Lifetime vs. Five-Year Risk Estimates for ESKD in US Adults with Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Obi, Yoshitsugu, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Zhu, Xiaoqian, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Tio, Maria Clarissa, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Yen, Timothy E., The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Dossabhoy, Neville R., The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Shafi, Tariq, Houston Methodist Hospital, Houston, Texas, United States
Background

The Kidney Failure Risk Equation (KFRE) estimates the short-term (2- or 5-year) risk of ESKD. Misinterpretation of this short-term risk as lifetime risk may lead to patient misunderstanding and suboptimal shared decision-making.

Methods

We analyzed data from 972 US adults aged 35-84 years with diabetes and eGFR 30 to <60 mL/min/1.73 m2 who participated in the 1999-2020 NHANES. Each sample was weighted to represent the general US population. We used the KFRE to calculate 5-year ESKD risk, and the Swedish National Diabetes Register prediction model (Østergaard, CJASN 2022) to estimate the lifetime ESKD risk where we calibrated baseline hazards for mortality and ESKD based on the national databases. We compared the distribution of lifetime risk across KFRE categories, further stratified by age groups.

Results

The mean age of the study cohort was 71 years, 52% were female, the median HbA1c was 6.8%, and the median duration of diabetes was 15 years. The mean eGFR was 49 mL/min/1.73 m2, and 53% and 43% had moderate and severe albuminuria, respectively. The 5-year risk of ESKD by KFRE (median 1.2% [IQR, 0.6% to 3.1%]) was consistently lower than the lifetime ESKD risk (median 22% [IQR, 12% to 42%]). This discrepancy was more pronounced in younger patients (Figure). For example, within the KFRE 1% to <5% risk category, the median estimated lifetime risk was 21% for age ≥70 years, 43% for age 60-69 years, and 53% for those <60 years.

Conclusion

The KFRE, a short-term ESKD risk estimate, substantially underestimates the lifetime risk of ESKD in patients with diabetes at every risk interval, particularly in the younger populations. Clinicians should consider lifetime ESKD risk estimates, rather than just short-term ESKD risk, when counseling patients with diabetes.

Funding

  • Other NIH Support