Abstract: TH-PO1228
Nine Million Candidates, Four in Five Unaware: The CKD Detection Gap Limiting Kidney-Protective GLP-1 Receptor Agonist Therapy in US Adults with Type 2 Diabetes
Session Information
- Late-Breaking Research Posters
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Akahara, Ozioma A., Houston Methodist Hospital, Houston, Texas, United States
- Nadeem, Saad, Texas A&M University System, College Station, Texas, United States
- Ayah, Omar A., Houston Methodist Hospital, Houston, Texas, United States
- Adrogue, Horacio E., Houston Methodist Hospital, Houston, Texas, United States
- Edwards, Angelina, Houston Methodist Hospital, Houston, Texas, United States
Background
Chronic kidney disease (CKD) is common among adults with type 2 diabetes (T2D), yet remains underrecognized, limiting opportunities for kidney-protective therapy. We estimated US adults meeting eligibility criteria for GLP-1 receptor agonists (GLP-1 RAs) and evaluated CKD awareness among these patients.
Methods
We pooled four NHANES cycles (2013–2014, 2015–2016, 2017–2018, and August 2021–2023; n=21,450 adults). CKD was defined using estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), with eGFR calculated using the 2021 race-free CKD-EPI equation. Among adults with diagnosed T2D, we evaluated eligibility per FDA/KDIGO guidelines (T2D with eGFR <60 mL/min/1.73 m^2 or UACR ≥30 mg/g) and strict FLOW trial eligibility. CKD unawareness was defined as laboratory evidence of CKD without prior communication. National estimates incorporated phlebotomy/MEC survey weights with Taylor-series linearized variance.
Results
An estimated 9.1 million US adults met FDA-label/KDIGO kidney-related eligibility criteria, while 0.94 million met strict FLOW criteria. Among FDA-label/KDIGO-indicated candidates, 82.3% were unaware of their CKD. Even among strict FLOW-eligible adults with more advanced kidney disease, 59.7% remained unaware. CKD unawareness was consistently high across demographic subgroups (79% to 89%). From 2013 to 2023, the candidate population increased from 8.2 to 10.4 million, while unawareness remained approximately 80% to 85%.
Conclusion
Most adults with T2D and laboratory-defined CKD who may benefit from kidney-protective GLP-1 RA therapy are unaware of their kidney disease. Systematic eGFR and UACR assessment and explicit CKD communication are critical to closing the gap between CKD detection and delivery of evidence-based kidney-protective therapy.
National GLP-1 RA kidney-protection eligibility and CKD unawareness, US adults with type 2 diabetes (NHANES 2013–2023)
| Eligibility tier | Unwt. n | US adults, millions (95% CI) | % of US adults (95% CI) | % Unaware of CKD (95% CI) |
| FDA-label / KDIGO-indicated (T2D + CKD) | 1,177 | 9.09 (8.38–9.80) | 3.98 (3.64–4.32) | 82.3 (79.1–85.6) |
| Strict FLOW trial-eligible | 150 | 0.94 (0.74–1.13) | 0.41 (0.32–0.49 | 59.7 (48.2–71.3) |
GLP-1 RA candidate population and CKD unawareness.