Kidney Week

Abstract: SA-PO152

Patient Motivation Scoring and Outcomes in the Diabetes CKD Clinic

Session Information

• Diabetic Kidney Disease: Clinical - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Hickson, LaTonya J., Mayo Clinic, Rochester, Minnesota, United States

LaTonya J. Hickson,

• Thorsteinsdottir, Bjoerg, Mayo Clinic, Rochester, Minnesota, United States

Bjoerg Thorsteinsdottir,

• Mara, Kristin C., Mayo Clinic, Rochester, Minnesota, United States

Kristin C. Mara,

• Upadhyaya, Sudhi, Mayo Clinic, Rochester, Minnesota, United States

Sudhi Upadhyaya,

• Lee, Minji, Mayo Clinic, Rochester, Minnesota, United States

Minji Lee,

• Zand, Ladan, Mayo Clinic, Rochester, Minnesota, United States

Ladan Zand,

• Enders, Felicity T., Mayo Clinic, Rochester, Minnesota, United States

Felicity T. Enders,

• Canzanello, Vincent J., Mayo Clinic, Rochester, Minnesota, United States

Vincent J. Canzanello,

Background

Given the global CKD burden, innovative methods to improve patient’s perception of autonomy and self-care are needed. We examined the association of variables in a patient motivation “Kidney and Heart Health” (KHH) Scoring system on CKD progression.

Methods

Diabetic-CKD (DM-CKD) patients were treated in a single-center, specialized clinic combining consultation from 1) hypertension-trained nurses and 2) physician/advanced practitioners. At each visit, patients were assigned points for meeting lifestyle (tobacco use, weight loss, alcohol use, exercise, and healthy diet) and objective (blood pressure, hemoglobin, LDL cholesterol, bone mineral metabolism, proteinuria, hemoglobin A1c, aspirin use) goals. CKD progression composite endpoint was defined as eGFR<10, dialysis, kidney transplant, or 40% reduction baseline eGFR. Time dependent cox hazards regression models examined the association between each KHH goal and CKD progression.

Results

From 2010-2016, 422 DM-CKD (eGFR 10-60mL/min/1.73m² inclusion) patients were treated; 61% male, 91% white, mean Charlson index 8.7±3.5, mean eGFR 31.8 ±12.1. Mean KHH score was 8.8±3.5 (out of 12). KHH categories with <75% patients reaching goal were: LDL (68%), weight (68%), bone metabolism (63%), exercise (51%), hemoglobin A1c (47%), and proteinuria (43%). Over 2.6 years (median), 177 met CKD progression composite endpoint (86 dialysis, 26 transplant, 53 eGFR <10, and 127 had 40% reduction eGFR). 82 died. Univariate hazard ratios for each category are shown, Figure. Multivariable models revealed older age, achieving BP, LDL, hemoglobin, bone metabolism, and exercise goals significantly associated with lower risk of CKD progression while weight and lower eGFR associated with higher risk compared to those not meeting lifestyle or objective goals.

Conclusion

Patient motivation scores used in a specialty CKD clinic relate to observed DM-CKD progression outcomes.

Funding

• NIDDK Support