POS-503 EVALUATING CHRONIC KIDNEY DISEASE PROGRESSION: A REPORT FROM THE DISCOVER CKD RETROSPECTIVE COHORT

Abstract

Rapid progression of chronic kidney disease (CKD) is associated with poor clinical outcomes. However, there is limited evidence on the epidemiology and characteristics of patients experiencing disease progression in a large multinational CKD population. DISCOVER CKD is an international observational study of patients with CKD that encompasses electronic medical records (EMR) and claims data between 2008 and 2020 from UK (primary care Clinical Practice Research Datalink [CPRD] linked to hospital data), US (TriNetX – hospital based EMR and Limited Claims and Electronic Health Record [LCED]) and Japan (Medical Data Vision [JMDV]). CKD patients (eGFR 15-74 ml/min/1.73 m2using CKD-EPI equation) aged ≥18 years (≥20 years for the JMDV database) were identified. Linear mixed effect models were used to calculate patient-level eGFR slopes over a five-year period post-index date (date of second confirmatory eGFR measurement) allowing for CKD stage at baseline categorized by eGFR. Those with annual eGFR decline >4 ml/min/1.73 m2 were considered rapid progressors. Rate of eGFR decline was assessed by baseline comorbidities. This study included more than 1.3 million patients with CKD and median (IQR) follow-up was 2.6 (1.2-4.6) years post index date (excluding LCED); in LCED 2.6 (1.3-4.0) years (Table 1). Overall, the estimated annual eGFR decline varied per data source (eGFR change per year in CPRD:-0.50ml/min/1.73m2; LCED: -1.14 ml/min/1.73 m2; TriNetX: -1.32 ml/min/1.73 m2; JMDV:-1.11 ml/min/1.73 m2). The annual rate of eGFR change (excl. LCED) in patients with Type 2 diabetes (T2D), hypertension (HTN) and heart failure (HF) was -1.61, -1.23 and -1.53 ml/min/1.73 m2,respectively. Overall (excl. LCED), 11% of patients experienced rapid eGFR decline with an estimated annual change in eGFR of -7.51 ml/min/1.73 m2. Rapid progressors had higher prevalence of diabetes, HTN and HF compared to patients with annual eGFR decline of ≤4 ml/min/1.73 m2. Approximately one in ten patients experienced rapid eGFR decline. Compared to non-rapid progressors, rapid progressors had a higher comorbidity burden. This indicates that more frequent monitoring and early proactive, multifaceted management of patients with CKD and comorbidities may have a positive impact on future kidney health.