Kidney Week

Abstract: SA-PO332

Competing Risks of Kidney Failure and Death by Baseline eGFR in Diabetes

Session Information

• Diabetic Kidney Disease: Clinical Pathology, Diagnostic and Treatment Advances
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Tuttle, Katherine R., Providence Health and Services, Spokane, Washington, United States

Katherine R. Tuttle, MD, FASN

• Kornowske, Lindsey M., Providence Health and Services, Spokane, Washington, United States

Lindsey M. Kornowske, MS

• Daratha, Kenn B., Providence Health and Services, Spokane, Washington, United States

Kenn B. Daratha, PhD

• Jones, Cami R., Providence Health and Services, Spokane, Washington, United States

Cami R. Jones, PhD

• Reynolds, Christina, Providence Health and Services, Spokane, Washington, United States

Christina Reynolds

• Koyama, Alain K., Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Alain K. Koyama, PhD

• Xu, Fang, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Fang Xu, PhD

• Miyamoto, Yoshihisa, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Yoshihisa Miyamoto, MD, PhD

• Neumiller, Joshua J., Providence Health and Services, Spokane, Washington, United States

Joshua J. Neumiller, PharmD

• Alicic, Radica Z., Providence Health and Services, Spokane, Washington, United States

Radica Z. Alicic, MD, MS

• Nicholas, Susanne B., University of California Los Angeles, Los Angeles, California, United States

Susanne B. Nicholas, MD, PhD, MPH

• Duru, Obidiugwu, University of California Los Angeles, Los Angeles, California, United States

Obidiugwu Duru, MD, MS

• Norris, Keith C., University of California Los Angeles, Los Angeles, California, United States

Keith C. Norris, MD, PhD

• Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Meda E. Pavkov, MD, PhD

Group or Team Name

• The CURE-CKD Registry.

Background

The study aim was to assess the competing risks of kidney failure and death in a real-world population with diabetes by baseline estimated glomerular filtration rate (eGFR).

Methods

Providence and University of California Los Angeles health systems provided electronic health record registry data for patients aged ≥12 years with diabetes in 2013-2022. Kidney failure was defined by eGFR <15 mL/min/1.73 m², dialysis, or kidney transplant. Follow-up started at diabetes identification and ended at onset of kidney failure, death, or last encounter. Cumulative incidence functions were assessed by baseline eGFR. Fine-Gray multivariable models for kidney failure were constructed with death as a competing risk.

Results

Among 619,352 people with diabetes, risk of death exceeded kidney failure for eGFR ≥45 mL/min/1.73 m² (Figure). At eGFR 30-44 mL/min/1.73 m², these risks were equivalent. At eGFR 15-29 mL/min/1.73 m², 5-year cumulative incidences of kidney failure and death were 62.3% and 15.3%, respectively, with an adjusted hazards ratio for kidney failure of 55.5 (95% CI 51.6-59.6; reference eGFR ≥90 mL/min/1.73 m²). Accounting for competing risk of death, other significant kidney failure predictors were male sex, non-White race, non-commercial health insurance, Providence health system, macroalbuminuria, age 40-59 years, or hospitalization during a 1-year baseline period.

Conclusion

Death was more frequent than kidney failure at eGFR ≥45 mL/min/1.73 m², but the trend reversed at lower eGFR with kidney failure becoming more much common at eGFR <30 mL/min/1.73 m². In the diabetes population, kidney and survival-based risk stratification may help to target management according to risk status.

Funding

• NIDDK Support