Measuring Both Albuminuria and eGFR Improves Renal Risk Stratification in Diabetes

Kenn Daratha, PhD

Credit: WSU Spokane

Findings from a recent study presented at the American Society of Nephrology Kidney Week 2023 are calling attention to an increased prevalence of major adverse kidney disease events among patients with diabetes and chronic kidney disease (CKD).

Patients with CKD who had baseline estimated glomerular filtration rate (eGFR) and albuminuria measurements available were more frequently categorized as having greater Kidney Disease Improving Global Outcome (KDIGO) risk, which was associated with an increased prevalence of major adverse kidney disease events.¹

“We found incredibly high rates for major adverse kidney events in a dose-dependent response by eGFR and albuminuria. This really validates the KDIGO heat map, which helps us identify the more severe cases of CKD and the corresponding event rate,” said Kenn Daratha, PhD, of Providence Medical Research Center, in an interview with HCPLive Nephrology.

According to the US Centers for Disease Control and Prevention, an estimated 1 in 3 adults with diabetes also has CKD.² The American Diabetes Association recommends urinary albumin and eGFR be assessed in people with type 1 diabetes with a duration ≥5 years and in all people with type 2 diabetes at least once every year. The recommendation increases to 1-4 times per year for patients with established diabetic kidney disease.³

To assess the risk of major adverse kidney disease events in a real-world population, Daratha and colleagues collected electronic health record data for patients aged ≥18 years with diabetes from the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) Registry at Providence and UCLA Health systems. Investigators followed patients beginning 6 months after diabetes identification until a 40% eGFR decline from baseline, eGFR <15 mL/min/1.73 m2, dialysis, or kidney transplant were observed, indicating a major adverse kidney disease event.¹

Investigators defined CKD as eGFR <60 mL/min/1.73 m2, UACR ≥30 mg/g, or UPCR ≥0.15 g/g. KDIGO risk categories ranged from low risk to very high risk based on average baseline eGFR and UACR/UPCR measurements. Baseline CKD status and KDIGO risk categories were used to assess the frequency of major adverse kidney disease events.¹

Among 285,036 patients with diabetes, the mean age was 61±16 years and 51% (n = 144,016) were female. Baseline UACR and UPCR measurements were available for 22.8% (n = 65,136) of the cohort.¹

At baseline, 21% (n = 60,672) of patients had CKD. The mean eGFR among this group was 56±24 mL/min/1.73 m2, the median UACR was 58 (interquartile range [IQR], 32.5-164) mg/g, and the median UPCR was 0.4 (IQR, 0.2-1.3). The frequency of major adverse kidney disease events was 27% in those with CKD compared to 14% in those without CKD.¹

Among patients with CKD who had baseline eGFR (100%), UACR (34.2%), and UPCR (4.3%) measurements, 37% were classified as high or very high KDIGO risk. Investigators noted major adverse kidney disease event frequency increased with greater KDIGO risk.¹

“We need measures of albuminuria. The majority of our patients don’t have any measures for that, which means we can’t put you on the KDIGO heat map. To improve the system, we need measures of albuminuria. The great thing today is we have therapies that can actually help, but if we’re not documenting the problem, there’s nothing we can do,” Daratha concluded.

References:

1. Tuttle KR, Kornowske LM, Jones CR, et al. Major Adverse Kidney Disease Events in a Real-World Population with Diabetes. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.
2. Centers for Disease Control and Prevention. Chronic Kidney Disease (CKD). Diabetes. December 30, 2022. Accessed November 6, 2023. https://www.cdc.gov/diabetes/managing/diabetes-kidney-disease.html
3. ElSayed NA, Aleppo G, Aroda VR, et al. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S191-S202. doi:10.2337/dc23-S011