Kidney Week

Abstract: SA-PO324

Characteristics of Patients with Type 1 Diabetes (T1D) and CKD Receiving Novel Kidney Protective Therapies (KPT)

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

• Caramori, M. Luiza A., Cleveland Clinic, Cleveland, Ohio, United States

M. Luiza A. Caramori, MD, MS, PhD

• Repetto, Enrico, Roche Diagnostics Corp, Indianapolis, Indiana, United States

Enrico Repetto, MD

• Perkins, Christopher, Roche Diagnostics Corp, Indianapolis, Indiana, United States

Christopher Perkins, MA

• Pandey, Ambarish, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Ambarish Pandey, MD

• Rossing, Peter, Steno Diabetes Center Copenhagen, Herlev, Capital Region of Denmark, Denmark

Peter Rossing, MD, DrMed

Background

KPT (SGLT2i, GLP-1RA and nsMRA) for pts with T2D and CKD have not been approved for pts with T1D and CKD. Regardless, a significant proportion of these pts receive these therapies. Herein, we used a case-control design to compare the characteristic of T1D pts with CKD treated or not with KPT and assessed kidney (Kd) outcomes.

Methods

Optum's De-identified Market Clarity database (1/1/2018-6/30/2023) was used to identify pts ≥18 yrs with T1D (Klompas algorithm) and CKD. CKD was defined as any two of CKD ICD-10 codes, eGFR<60 ml/min/1.73m², or UACR≥30 mg/g, ≥3 months apart. Pts on dialysis or who had a Kd transplant were excluded. KPT use was defined as any KPT prescription that was refilled ≤180 days from KPT start (index date). An index date was randomly assigned to pts not on KPT (no-KPT). Outcome analysis included T1D CKD pts who had UACR data available ≤540 days prior to and ≥30 days after index date.

Results

Among 408,951 pts with T1D, 128,675 (31.5%) had CKD. 1,970 pts (1.5% of T1D CKD pts) were on KPT, 41% of them on SGLT2i, 70% GLP-1RA , and 3% nsMRA; 14% were on more than one KPT. Pts on KPT were more often females (57 vs 50%), less often White (71 vs 78%), and had higher UACR [157 (114-200) vs 113 (92-135) mg/g] than pts not on KPT, respectively. Proportion of non-Hispanic (75 vs 76%), age (51±13 vs 52±17 yrs) and eGFR (60±28 vs 62±30 mL/min/1.73m²) were not different. Time to 50% ≥30% UACR reduction (Fig) was 31 (25-47) vs 47 (43-53) months in the KPT (n=381) vs no-KPT (n=3385) cohort, respectively (HR1.24, p≤0.02).

Conclusion

We identified a large number of pts with T1D and CKD treated with off-label KPT. Pts on KPT were more often female and non-White and had more advanced Kd disease as evidenced by higher baseline UACR. The proportion of pts with T1D and CKD achieving clinically meaningful UACR reduction (≥30%) was greater among KPT users and comparable to what was observed among pts with T2D and CKD, supporting the need for trials in T1D.

Funding

• Commercial Support – Roche: database acquisition, ER and CP efforts