Abstract: FR-PO0345
Progression of CKD in Patients with and Without Type 2 Diabetes (T2D) with Mortality as a Competing Risk
Session Information
- Diabetic Kidney Disease: Progression, Predictive Tools, Therapeutics, and Outcomes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Mares, Jon, Bayer Corporation, Whippany, New Jersey, United States
- Taliercio, Jonathan J., Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Zajichek, Alex, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Shokles, Cassidy, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Milinovich, Alex T., Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Katta, Arvind, Bayer Corporation, Whippany, New Jersey, United States
- Martyn-Dow, Blaine, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Misra-Hebert, Anita D., Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Aldworth, Carolina A R, Bayer Corporation, Whippany, New Jersey, United States
- Zimmerman, Robert, Bayer Corporation, Whippany, New Jersey, United States
- Pantalone, Kevin M., Bayer Corporation, Whippany, New Jersey, United States
- Rotroff, Daniel M, Bayer Corporation, Whippany, New Jersey, United States
Background
The Kidney Disease: Improving Global Outcomes (KDIGO) heatmap is an accepted tool for early CKD recognition & progression based on eGFR & albuminuria levels. Staging limitations include omission of diabetes status & inability to project progression timing.
Methods
Using Cleveland Clinic EMR data (12/1/11-8/1/24), we identified 29,985 adults with moderate/high CKD risk per KDIGO. Eligible patients had 2 eGFR or UACR measurements 90-365 days apart. Index date was earliest record of 2 consecutive/consistent KDIGO risk categories. Patients were compared by baseline T2D status. The main outcome was CKD stage progression, defined as first transition from original to a higher risk category. Follow-up continued until CKD progression to any higher category, end of data, or death.
Results
In eligible moderate-risk patients (n=16,763), progression rates were similar in those with & without T2D (P=0.30); in high-risk (n=7,242), progression rates were similar until Month 25, when T2D patients were more likely to progress than those without (P=0.003). Patients diagnosed with T2D before CKD (moderate risk, n=13,610; high risk, n=5,338) were less likely to progress compared to those with CKD before T2D (both P<0.0001), irrespective of initial KDIGO risk category.
Acute events (ie, myocardial infarction, congestive heart failure, stroke/cerebrovascular accident, or AKI) were associated with lower chance of CKD progression, regardless of initial risk or T2D status (P<0.001 for most events), due to high mortality rates. In survival analyses, incorporation of death as a competing factor minimized the association of acute events with CKD progression as patients were more likely to die prior to progressing.
Conclusion
Risk of CKD progression was high regardless of T2D diagnosis. High risk patients with T2D progressed faster after 2 years than those without T2D. Acute events were associated with increased mortality, reducing the likelihood that patients will survive long enough to experience CKD progression. Identifying risk factors for acute events and addressing residual CV risk are important in CKD patients at moderate to high progression risk.
Funding
- Commercial Support – Bayer HealthCare