MO637THE HIDDEN PREVALENCE OF DIABETIC KIDNEY DISEASE IN A HOSPITAL-BASED REAL-WORLD DATA ANALYSIS

Abstract

Abstract Background and Aims Correct identification of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients is crucial to implement therapeutic interventions to prevent disease progression and premature death. Method We have analyzed the prevalence of DKD according to lab criteria and the rate of identification of DKD and/or chronic kidney disease (CKD) on 516,578 hospital care electronic medical records (EMR) in a tertiary hospital-based population using Savana Manager®. Results Out of 24,129 T2DM patients, 15,304 met inclusion criteria. DKD was defined as eGFR<60 ml/min/1.73m2 or urinary albumin to creatinine ratio (UACR) >30 mg/g or urinary protein to creatinine ratio (UPCR) >0.3 g/g after excluding acute kidney injury (AKI). A total of 4,526 (29.6%) T2DM patients had DKD according to lab criteria. However, the terms “CKD” or “DKD” were only present in 33.1% and 7.5% of the 4,526 EMR, with a hidden prevalence of CKD and DKD of 66.9% and 92.5%, respectively. Less severe kidney disease (lower UACR or UPCR, higher eGFR values), female sex, and lack of insulin prescription were associated with the absence of “DKD” or “CKD” terms in EMR (p<0.001) in the patients fulfilling laboratory criteria for DKD. However, while younger age (<70 years) was associated with a missing CKD diagnosis, older age (≥70 years) was associated with a missing DKD diagnosis in EMR. Conclusion In conclusion, the prevalence of DKD among T2DM patients according to laboratory data is higher than prevalence based on specific diagnosis written in EMR. This could imply underdiagnosis of DKD, especially in patients with less severe disease who may benefit the most from optimized therapy