Kidney Week

Abstract: SA-PO0415

Sounds of Silence: Major Adverse Cardiovascular Events Uncovers Highest Risk in Native Hawaiian and Pacific Islander Patients with Kidney-Metabolic Dysfunction in Hawai'i

Session Information

• CKM: Clinical - Epidemiology and 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

• Hayashi, Jeffrey W., University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, United States

Jeffrey W. Hayashi, MD

• Velasco, Alicia Ainsley, The Queen's Medical Center, Honolulu, Hawaii, United States

Alicia Ainsley Velasco, MPH

• Seto, Todd, The Queen's Medical Center, Honolulu, Hawaii, United States

Todd Seto, MD

• Davis, James, The Queen's Medical Center, Honolulu, Hawaii, United States

James Davis, PhD

• Ortega, Michael, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, United States

Michael Ortega, PhD

• Izutsu, Christie H., The Queen's Medical Center, Honolulu, Hawaii, United States

Christie H. Izutsu, MD, FASN

• Kim, Lisa, The Queen's Medical Center, Honolulu, Hawaii, United States

Lisa Kim, MD

Background

CKD is a silent but major contributor to morbidity and mortality but recent proliferation of SGLT2i and GLP1 agonists show favorable outcomes using major adverse cardiovascular events (MACE) as a measurable endpoint. The burden of CKD and type 2 diabetes (T2DM) in our institution is high due to unique patient demographics compared to other centers using Epic EHR. Better self-reporting among Asians and Native Hawaiian and Pacific Islander (NHPI) in Hawai’i may uncover significant differences in outcomes research.

Methods

Epic Cosmos utilization during an institution wide datathon on 3/3/26 identified MACE in patients with underlying CKD (N18.*) diagnosed within 18 months of defining event, with or without T2DM between 1/1/2018 and 12/31/2025. Queen's Hospital System (QHS) was isolated and compared with Epic Cosmos.

Results

NHPI-CKD patients in the QHS cohort (Fig 2) without diabetes had an all time high MACE rate of 25.54% (95% CI 24.34–26.74%) in 2025 in contrast to tracking with White patients at a rate of 10% in the Cosmos cohort (Fig 1). While all CKD patients with T2DM (+) have higher rates of MACE, NHPI at QHS were found with 37% MACE (3,084/ 8,327 patients); White 32.6% (1,393/4,273): Asian 27.16% (5,025/18,501) compared to Cosmos cohort with NHPI at 19.16% (5,306/27,695 patients); White at 17.63% (444,759/2,522,598) and Asian 14.34% (20,159/140,616).

Conclusion

NHPI patients with underlying CKD and T2DM have highest percentage of MACE compared to Asian and White. Multicentered trials may not adequately address mechanisms driving CKD or T2DM in NHPI patients. More studies are needed to determine if MACE in our institution can be attenuated by new therapeutics.

Fig 1

Fig 2