Incidence of Chronic Kidney Disease and Progression of Renal Dysfunction in Type 2 Diabetes-The Role of Albuminuria

Abstract

Chronic kidney disease (CKD) is typically assessed by estimated glomerular filtration rate (eGFR), but the predictive value of albuminuria to worsening eGFR in routine clinical practice has not been well documented. We calculated the rate of progression of renal dysfunction measured by eGFR for clinically recognized categories of albuminuria. Using a longitudinal design and the electronic medical records of Kaiser Permanente Northwest, we identified 13,358 diabetes patients who had a serum creatinine (SCr) and urine albumin creatinine ratio (UACR) in 2006-2012 and at least one subsequent measure of each 2006-2016. From those values, we allocated each patient to a baseline eGFR and UACR category according to Kidney Disease: Improving Global Outcomes guidelines. We then calculated progression rates to each higher category of eGFR per 1,000 person-years (p-y) over 11 years of follow-up adjusted for age, sex, race/ethnicity, systolic blood pressure, and use of angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin II receptor antagonists (ARB). We compared these rates by baseline UACR categories. Higher levels of albuminuria at baseline significantly increased the risk of progression of eGFR-based kidney dysfunction (Table). Our results from routine clinical practice demonstrate the key role of albuminuria in the worsening of renal function in a general diabetes population. Disclosure G. Nichols: Research Support; Self; Boehringer Ingelheim GmbH, Amarin Corporation, Janssen Pharmaceuticals, Inc., Sanofi. A. Deruaz-Luyet: Employee; Self; Boehringer Ingelheim GmbH. S. Hauske: Employee; Self; Boehringer Ingelheim GmbH. K. Brodovicz: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc..