Risk of Adverse Renal Outcomes in CKD Patients with Diabetes in DISCOVER-CKD

Kidney Week 2020

Patients with chronic kidney disease (CKD) with type 2 diabetes are at high risk for cardiovascular events. However, according to researchers there are few data available on the excess risk of kidney events in patients CKD and diabetes compared with those without diabetes.

During a virtual poster at ASN Kidney Week 2020, Alyshah Abdul Sultan, MSc, PhD, and colleagues reported on results of an analysis of data from DISCOVER-CKD, an international observational study examining real-world management of CKD. The poster was titled Defining the Risk of Adverse Kidney Outcomes in CKD Patients with Type 2 Diabetes in the DISCOVER-CKD Cohort.

DISCOVER-CKD encompasses large retrospective electronic medical records (EMRs) and claims data between 2008 and 2020. The current analysis examined data from US-based Limited Claims and Electronic Health Record (LCED) (IBM Health, Armonk, New York) and TriNetX (hospital-based EMR).

The analysis identified patients with CKD, defined as estimated glomerular filtration rate (eGFR) <75 mL/min/1.73 m², ≥18 years of age with more than one record of urine albumin to creatinine ratio (UACR). Index was defined as the second eGFR measurement. Diabetes status was ascertained any time prior to the index date. The risk of kidney outcomes, defined as decline in eGFR of 50% or more or end-stage kidney disease, was compared between patients with and without type 2 diabetes at 5 years of follow-up.

Compared with the cohort without diabetes, those with diabetes had slightly higher incidence rates of adverse renal outcomes (LCED: 2.7% vs 2.3% per year; TriNetX: 1.8% vs 1.2% per year). Following adjustment for confounders, there was no increased risk of adverse renal outcomes in patients with CKD and type 2 diabetes compared with those with CKD and no type 2 diabetes in LCED: hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.81-1.43. In the TriNetX database, there was a 34% increased risk of adverse renal outcomes in the cohort with diabetes compared with those without diabetes (HR, 1.34; 95% CI, 1.11-1.62).

In summary, the researchers said, “There is an excess risk of adverse renal outcomes in CKD patients with type 2 diabetes compared with those without type 2 diabetes. This is explained to a large extent by conventional risk markers in LCED but not completely in TriNetX. Both groups (type 2 diabetes and non-type 2 diabetes) should be managed proactively to reduce the risk of poor clinical outcomes.”

Source: Abdul Sultan A, Nolan S, Carrero JJ, et al. Defining the excess risk of adverse kidney outcomes in CKD patients with type 2 diabetes in the DISCOVER-CKD cohort. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2020 (Abstract PO0436), October 22, 2020. Funding for this poster was provided by AstraZeneca.