Kidney Week

Abstract: SA-PO0417

Albuminuria and Progression to ESKD in Adults with Diabetes: A Retrospective Cohort Study of Sex, Ethnic, and Age Disparities

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

• Jahanshahi, Atousa, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States

Atousa Jahanshahi, MD

• Arevalo Iraheta, Yaquelin, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States

Yaquelin Arevalo Iraheta

• Mendoza, Sofia, University of California Los Angeles, Los Angeles, California, United States

Sofia Mendoza

• Le, May, University of California Los Angeles, Los Angeles, California, United States

May Le

• Markovic, Daniela, University of California Los Angeles, Los Angeles, California, United States

Daniela Markovic, MS

• Kamgar, Mohammad, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States

Mohammad Kamgar, MD, FASN

• Nicholas, Susanne B., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States

Susanne B. Nicholas, MD, PhD, MPH

• Nobakht, Niloofar, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States

Niloofar Nobakht, MD, FASN

Background

Chronic kidney disease (CKD) affects over 35 million Americans, yet only 12.3% are aware of their diagnosis and fewer than 20% of at-risk patients receive guideline-concordant albuminuria testing. Albuminuria is a key marker of diabetic kidney disease progression, but real-world characterization of its association with end-stage kidney disease (ESKD) across demographic groups remains limited. We evaluated observed progression to ESKD in adults with diabetes, focusing on albuminuria severity and disparities by sex, ethnicity, and age.

Methods

We conducted a retrospective cohort study using the UCLA i2b2 Electronic Medical Record<!--TgQPHd|[]--> (EMR) database (2016–2026). We identified 161,291 adults with diabetes, including 77,911 with CKD. Albuminuria was documented in 1,815 patients with values >30 mg/g and 500 patients with values >300 mg/g. We assessed progression to ESKD within a longitudinal EMR cohort of adults with diabetes and calculated unadjusted progression rates across albuminuria strata and demographic subgroups.

Results

Overall, progression to ESKD occurred in 2.05% of adults with diabetes. Among patients with documented albuminuria, progression increased in a stepwise manner: 8.21% in those with albuminuria >30 mg/g to 19.00% in those >300 mg/g. Males demonstrated higher observed progression than females at severe albuminuria levels (21% vs 15%). The highest observed progression rates were seen among Mexican/Mexican American patients, reaching up to 46% in the severe albuminuria group. Adults ≥55 years accounted for the largest absolute burden of ESKD. Progression to ESKD was associated with higher observed mortality across all subgroups.

Conclusion

In this large EMR-based cohort of adults with diabete, albuminuria was documented in only 1.13% of adults with diabetes, suggesting potential under-documentation of albuminuria testing in routine clinical practice. Among patients with documented albuminuria, severity was strongly associated with progression to ESKD, with marked sex and ethnic disparities. The highest observed rates were seen among Mexican/Mexican American patients. These findings highlight the need for universal albuminuria screening and targeted interventions in high-risk populations to reduce CKD progression and mortality.