Abstract: SA-PO0454
Delays in Nephrology Care Among Patients with Diabetes at High Risk for ESKD
Session Information
- CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Kowalczyk, Nicholas Stanley, The University of Chicago, Chicago, Illinois, United States
- McGill, Rita L., The University of Chicago, Chicago, Illinois, United States
- Yang, Danwei, The University of Chicago, Chicago, Illinois, United States
- Laiteerapong, Neda, The University of Chicago, Chicago, Illinois, United States
- Saunders, Milda R., The University of Chicago, Chicago, Illinois, United States
Background
Prior studies have demonstrated that timely referral to nephrology for patients at high risk for ESKD is low. We sought to evaluate for delays in nephrology care among patients with diabetes identified as high-risk for developing ESKD at an urban tertiary academic medical center.
Methods
We identified 3,896 patients at high risk for ESKD based on a KFRE >3%, UACR ≧300, or eGFR <45 from a cohort of 28,482 patients with type 2 diabetes mellitus who had >1 visit in primary care, endocrinology, or nephrology (2019-2025). Patients were followed for 2 years from index high-risk lab until nephrology referral order placed or seen by nephrology. Multivariable associations between patient characteristics and time to nephrology referral or visit were examined.
Results
Only 20% of high-risk patients were referred/seen (R/S) by nephrology within 2 years of being classified as high risk for ESKD. Any level of albuminuria including UACR <30 (OR 4.10; p<0.001) was associated with higher odds of being R/S compared to eGFR alone. Individuals with a normal eGFR (>60) or no eGFR were less likely to be R/S than eGFR 30-59 (Ref) or eGFR <30 (OR 1.67, p<0.001). Women were less likely to be R/S (OR 0.85; p=0.04) compared to men. Patients with HTN (OR 0.77, p<0.001) or tobacco use (OR 0.71, p=0.01) were less likely to be R/S. Patients with more than one admission in the prior year were less likely to be R/S (OR 0.62, p=0.002).
Conclusion
Delays in nephrology care for patients with diabetes at high risk for ESKD persist particularly among women, patients with hypertension or tobacco use, and patients with frequent admissions. Patients who had any UACR done were more likely to be referred/seen regardless of level of albuminuria, as if they had an abnormal eGFR, demonstrating importance to emphasize dual screening with both eGFR and UACR for appropriate risk identification.
Funding
- NIDDK Support