DOI: 10.1161/circ.148.suppl_1.13951 ISSN: 0009-7322

Abstract 13951: Change in Albuminuria Measured by Urine Albumin-to-Creatinine Ratio (UACR) and Associated Clinical Outcomes in Patients With Chronic Kidney Disease (CKD) Associated With Type 2 Diabetes (T2D)

Navdeep Tangri, Qixin Li, Yan Chen, Rakesh Singh, Keith A Betts, Youssef M Farag, Scott Beeman, Yuxian Du, Sheldon X Kong, Todd Williamson, Aozhou Wu, Manasvi Sundar, Kevin M Pantalone
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: The impact of change in albuminuria measured by UACR on key clinical outcomes (overall survival [OS], a composite cardiovascular [CV] outcome, and kidney disease progression) in patients (pts) with CKD associated with T2D is understudied.

Hypothesis: A decreased UACR is associated with a lower risk of clinical outcomes, while an increased UACR is associated with a higher risk of clinical outcomes.

Methods: Adult pts with an elevated UACR ≥30 mg/g (initial test) after T2D and CKD diagnosis were identified from the Optum EHR database (1/2007-9/2021). UACR change was categorized as increased (>30% change), stable (-30% to 30%), or decreased (<-30%) based on the percentage change between the initial test and the last test (between 6 to 24 months after the initial test). Clinical outcomes, including OS, a composite CV outcome (CV death, myocardial infarction, stroke, or heart failure hospitalization), and kidney disease progression (≥40% eGFR decline or kidney failure) were evaluated after the last UACR test using Kaplan-Meier analysis. Hazard ratios (HR) of clinical outcomes for UACR change were estimated using Cox proportional hazard models adjusting for baseline characteristics.

Results: Among 160,382 pts (median follow-up: 2.9 years), 89,562 had decreased UACR, 35,117 had stable UACR, and 35,703 had increased UACR. Compared with pts with stable UACR, pts with decreased UACR had significantly lower risks for all clinical outcomes (Figure) with adjusted HR of 0.93 for OS, 0.93 for the composite CV outcome, and 0.84 for kidney disease progression, while pts with increased UACR had significantly higher risks for OS (HR=1.24), the composite CV outcome (HR=1.24), and kidney disease progression (HR=1.41).

Conclusions: In pts with CKD associated with T2D, >30% UACR decrease was associated with a lower long-term risk of overall mortality, CV events, and kidney disease progression. These findings highlight the importance of albuminuria monitoring in these pts.

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