Abstract: TH-OR053
Disparities in CKD Screening and Therapy Among Older Veterans with Type 2 Diabetes
Session Information
- CKD Outcomes: Novel Biomarkers, Interventions, and Multiorgan Crosstalk
October 22, 2026 | Location: Mile High Ballroom 1D, Convention Center
Abstract Time: 05:40 PM - 05:50 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
Authors
- Sinclair, Matthew R., Duke University School of Medicine, Durham, North Carolina, United States
- Brown, John C., Durham VA Health Care System, Durham, North Carolina, United States
- El-Zaatari, Helal, Durham VA Health Care System, Durham, North Carolina, United States
- Berkowitz, Theodore S. Z., Durham VA Health Care System, Durham, North Carolina, United States
- Weidenbacher, Hollis J., Durham VA Health Care System, Durham, North Carolina, United States
- Bowling, C. Barrett, Durham VA Health Care System, Durham, North Carolina, United States
Background
CKD is a common and underrecognized complication of type 2 diabetes (T2D), disproportionately affecting older adults and racially and ethnically minoritized populations. While guidelines recommend annual urine albumin-to-creatinine ratio (UACR) screening in all patients with T2D to optimize guideline directed medical therapy (GDMT) and slow CKD progression, both UACR screening and GDMT remain underutilized. We aimed to determine how age, race/ethnicity, and other factors affect UACR screening and GDMT among older Veterans.
Methods
We conducted a retrospective cohort study of 4,275 Veterans aged ≥65 years with T2D receiving care at the Durham VA Medical Center. Using Veterans Health Administration (VHA) electronic health record data, we examined UACR screening, renin-angiotensin system inhibitor (RASi) use, and sodium-glucose co-transporter 2 inhibitor (SGLT2i) or glucagon-like peptide-1 receptor agonist (GLP-1 RA) use within one year of the most recent hemoglobin A1c measurement. Multivariable logistic regression models evaluated associations between demographics, CKD severity, frailty, and comorbidities with each outcome.
Results
UACR screening was done in 63% of Veterans within the prior year. Veterans aged ≥75 were less likely to have UACR screening (OR 0.85, 95% CI 0.74-0.98) or receive a SGLT2i/GLP-1 RA (OR 0.69, 95% CI 0.59-0.82) compared to those aged 65-74. The frailest Veterans were less likely to receive UACR screening compared to nonfrail Veterans (OR 0.65, 95% CI 0.44-0.95). Veterans with UACR > 300 mg/g had much higher odds of receiving a RASi (OR 2.33, 95% CI 1.54-3.64) compared to those with UACR <30 mg/g. While race/ethnicity were not associated with UACR screening, Black Veterans were more likely to use a RASi (OR 1.37, 95% CI 1.17-1.61) but less likely to use a SGLT2i/GLP-1 RA (OR 0.83, 95% CI 0.7-0.98) compared to White Veterans. Individuals who had visited a nephrologist were more likely to receive a RASi (OR 1.55, 95% CI 1.14-2.15) and/or SGLT2i/GLP-1 RA (OR 1.38, 95% CI 1.02-1.88).
Conclusion
Advanced age and frailty were independently associated with lower UACR screening. Lack of UACR screening was associated with lower use of SGLT2i/GLP-1 RA. Black Veterans were more likely to receive RASi therapy but less likely to receive newer cardioprotective agents. Targeted, age- and vulnerability-informed implementation strategies are needed to improve equitable CKD care within the VHA.
Funding
- Veterans Affairs Support