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Disclosures: Mullins’ reports have received consulting fees from AstraZeneca, Bayer Pharmaceuticals, Incyte, Merck, Pfizer, Sanofi and Takeda.
Over a 5-year period, 18.9% of patients with chronic kidney disease and type 2 diabetes progressed from baseline moderate or high risk to very high risk.
In addition, an altered urine albumin to creatinine ratio (UACR) correlated with more rapid progression.
“The Kidney Disease: Improving Global Outcomes (KDIGO) clinical guidelines characterize CKD prognostic risk categories using glomerular filtration rate and UACR,” C. Daniel Mullins, PhD🇧🇷 professor and chair of the University of Maryland Health Services Pharmaceutical Research Department, and colleagues wrote. “Using a US electronic medical record database of patients with type 2 diabetes (T2DM), this study assessed the risk of CKD progression across KDIGO risk categories and quantified the economic burden by progression group.”
In a retrospective cohort study, researchers surveyed 269,187 adults with T2DM and moderate to severe CKD in the Optum Electronic Health Records database between January 2007 and December 2019.
The researchers determined KDIGO risk categories based on two eGFR measurements of patients establishing the same eGFR stage and a UACR measurement obtained after at least 1 year of the established eGFR stage. These stages included moderate to high/very high risk and high to very high risk. The researchers measured health resource utilization with hospitalizations, emergency room visits, and outpatient visits during the study period.
Using cumulative incidence, the researchers calculated the probability of progression. In addition, the researchers compared health resource utilization and medical costs between progression groups.
Over a 5-year period, the researchers observed that 18.9% of patients progressed to the very high-risk category. Similarly, 17.8% of those with stage G1-A2 CKD, 44% of those with stage G2-A2 CKD, and 61.3% of those with stage G3a-A1 CKD progressed to a higher KDIGO risk category. Furthermore, 63.9% of those with CKD stage G3b-A1/G3a-A2 and 56% of those with CKD stage G2-A3 progressed to very high risk.
A higher UACR stage correlated with a four to seven times greater risk of progressing to very high risk and more rapid eGFR decline. Patients who did not progress experienced $16,924 in annual medical costs compared to $22,117 for those who progressed from moderate risk to high risk. The annual medical cost increased to $35,092 for those who progressed from moderate to very high risk.
“In conclusion, in this retrospective study, patients with T2DM and CKD who were in the moderate or high KDIGO risk categories at the index date were highly likely to progress to a higher risk category within 5 years. Furthermore, an impaired UACR was associated with faster progression. Patients who progressed to a higher risk category incurred significantly greater utilization of healthcare resources and medical costs compared to those without progression,” wrote Mullins and colleagues. “These results underscore the high clinical and economic burdens associated with progression of CKD defined using eGFR and UACR, and highlight the value of UACR in the management of CKD.”