Kidney Week

Abstract: TH-PO0645

Disease Progression and Cardiorenal Outcomes in Patients with CKD Across Urine Albumin-to-Creatinine Ratio (UACR) Levels in Three Large Real-World Study Populations

Session Information

• CKD: Clinical - Guidelines, Biomarkers, Progression, Procedures, Outcomes, and More
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Chang, Tara I., Stanford University School of Medicine, Stanford, California, United States

Tara I. Chang, MD, MS, FASN

• Pecoits-Filho, Roberto, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil

Roberto Pecoits-Filho, MD, PhD, FASN

• Svensson, Maria K., Uppsala University, Uppsala, Sweden

Maria K. Svensson, MD, PhD

• Adamsson Eryd, Samuel, AstraZeneca, Gothenburg, Sweden

Samuel Adamsson Eryd, PhD

• Aranda, Unai, AstraZeneca, Gaithersburg, Maryland, United States

Unai Aranda

• Bodegard, Johan, RWE Research, Oslo, Norway

Johan Bodegard, MD, PhD

• Enxing, Joshua, AstraZeneca, Cambridge, United Kingdom

Joshua Enxing, MS, MSc

• Karlberg, Olof, Sence Research AB, Uppsala, Sweden

Olof Karlberg, PhD

• van Haalen, Heleen, AstraZeneca, Gothenburg, Sweden

Heleen van Haalen

• Levin, Adeera, University of British Columbia, Vancouver, British Columbia, Canada

Adeera Levin, MD

• Tuttle, Katherine R., Providence Health Care and University of Washington, Spokane, Washington, United States

Katherine R. Tuttle, MD, FASN

• Burton, James, University of Leicester, Leicester, United Kingdom

James Burton, MBChB, PhD, FASN

Background

Albuminuria is a major risk factor for adverse cardiorenal outcomes and mortality. The study aim was to determine associations between albuminuria and risks of these adverse outcomes in three contemporary real-world populations with CKD.

Methods

Adults with CKD were identified from healthcare databases in England (Clinical Practice Research Datalink Aurum) and the USA (Optum's de-identified Clinformatics^® Data Mart) using an index date of January 1, 2022, and from registries in Sweden using an index date of January 1, 2020. Patients with T1D, ESKD/kidney failure or pregnancy were excluded. Patients were stratified by UACR at baseline. Adjusted annual eGFR slope was estimated using quantile regression. Risks of severe kidney outcomes (kidney failure/death), cardiorenal (CKD or heart failure) hospitalizations and all-cause death were estimated by Cox proportional hazards models adjusted for age, sex, baseline eGFR, T2D and heart failure. Continuous risk associations were assessed using adjusted spline models.

Results

We identified 233 001 patients with albuminuria from England, 41 513 from Sweden and 433 677 from the USA. Mean age at index was 67−75 years, 31−56% were female and 53−85% had type 2 diabetes. Increasing UACR was associated with progressively steeper eGFR decline, becoming markedly steeper from ≥ 700 mg/g with slopes of −5.73 (England), −4.81 (Sweden) and −4.32 (USA) mL/min/1.73 m²/year. Using data pooled across countries, the hazard ratios (95% CI) at 1 year were 5.2 (4.2–6.5) for severe renal outcomes, 2.1(1.9–2.3) for cardiorenal hospitalization and 2.2 (1.9–2.5) for all-cause death, for UACR ≥ 700 mg/g vs UACR < 10 mg/g. Continuous associations demonstrated non-linear relationships between UACR and risks, with a clear inflection point at UACR ≥ 700 mg/g (Figure).

Conclusion

Patients with high-risk proteinuric CKD (UACR ≥ 700 mg/g) constitute a population at heightened risk of rapid progression and adverse clinical outcomes, including all-cause death.

Funding

• Commercial Support – AstraZeneca