Abstract: SA-PO771
GFR Decline Based on Albuminuria Status in Patients with DM, Hypertension, and eGFR≥60
Session Information
- CKD: Epidemiology, Risk Factors, Prevention - III
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Liew, Adrian, Tan Tock Seng Hospital, Singapore, Singapore
- Ang, Yee, National Healthcare Group, SIngapore, Singapore
- Yap, Chun wei, National Healthcare Group, SIngapore, Singapore
- Lim, Chee Kong, National Healthcare Group Polyclinics, Singapore, Singapore
- Weng, Wanting, Tan Tock Seng Hospital, Singapore, Singapore
Background
In patients with GFR≥60, CKD is defined by presence of 2 albuminuria (UACR), obtained 3 months apart. Often, due to the clinical stability of these patients and limited clinic resources, most patients ended up with 1 UACR done annually with a potential delay in CKD diagnosis and treatment. We postulate that a single UACR reading in DM and hypertensive patients at high risk for the development of CKD, could have a significant impact in the progression of CKD. Our study aims to determine the eGFR decline in patients with only 1 UACR reading at baseline compared to those who meets the traditional criteria for CKD of 2 readings.
Methods
In this retrospective cohort study, we included patients with DM or hypertension, GFR≥60, from 9 primary care clinics between 2010 to 2014. UACR results were obtained for up to 2 years prior to study period, and patients were stratified into 3 groups (Gp) – Gp 1: normal UACR; Gp 2: 1 abnormal ACR; Gp 3: 2 abnormal UACR at least 90 days apart. The patients were followed up for 2 years and GFR decline were compared, and adjusted for age, ethnicity, HbA1c, blood pressure and ACEi use.
Results
Of 11,783 patients in the study, 85.4% have DM. Baseline parameters between groups were similar. Malay patients with DM was found to have a greater GFR decline (-1.0 [-1.6, -0.4], p<0.001), consistent with previous reports. Unadjusted GFR decline, when stratified by DM status, was greater for those with positive UACR (See table). GFR decline was similar between Gp 2 and 3, especially in DM patients. In the multivariate analysis with Gp 1 as reference, GFR decline was similar between Gp 2 and 3 in diabetic patients, but higher in Gp 3 in hypertensive patients.
Conclusion
In diabetic and hypertensive patients, albuminuria was associated with greater GFR decline. GFR decline was similar regardless of 1 or 2 UACR results, especially in patients with DM. This suggests that treatment should be considered with a single albuminuria result before a second reading is needed to meet the CKD definition.
| Unadjusted GFR Decline (DM) | Unadjusted GFR Decline (Non-DM) | |||
| GFR≥90 | GFR 60-89 | GFR≥90 | GFR 60-89 | |
| Gp 1 | -2.0±4.6 | -0.9±5.7 | -1.7±4.2 | -1.1±5.5 |
| Gp 2 | -3.8±6.4 | -3.0±7.1 | -2.7±5.0 | -2.2±6.2 |
| Gp 3 | -3.2±5.5 | -3.0±7.0 | -3.9±5.8 | -3.5±5.7 |
| GFR Decline after Multivariate Analysis | ||||
| Gp 1 | Reference | |||
| Gp 2 | -1.5 (-1.8 to -1.1) p<0.001 | -1.8 (-2.2 to -1.5) p<0.001 | -1.0 (-1.7 to -0.4) p=0.003 | -1.1 (-1.8 to -0.3) p=0.008 |
| Gp 3 | -1.0 (-1.6 to -0.4) p<0.001 | -1.8 (-2.4 to -1.3) p<0.001 | -2.1 (-3.5 to-0.7) p=0.003 | -2.4 (-4.2 to-0.7) p=0.006 |