HbA1c-dependent projection of long-term renal outcomes

. Arnold F, Kappes J, Rottmann FA, West-ermann L, Welte T. HbA1c-dependent projection of long-term renal outcomes. J Intern Med . 2024; 295 :206–15. Background. Diabetes mellitus is a major risk factor for the development of chronic kidney disease (CKD). There is limited data addressing the value of glycated hemoglobin (HbA1c) to predict renal outcomes independent of diabetes status. Methods

increase of 1 µg/m 3 in SO 2 (1.06, 1.00-1.13)concentration were also positively associated with ESRD.Apart from NO 2 , all the above air pollutants have additional predictive value for ESRD in patients with T2DM and CKD, with PM 2.5 performing best.
Conclusions: In patients with T2DM and CKD, long-term exposure to PM 2.5 , PM 10 , CO, and SO 2 was positively associated with the risk of ESRD.
Funding: Government Support -Non-U.S.  Background: Diabetes is often compounded with chronic kidney disease, and both diseases are becoming more prevalent.However, epidemiological data on Diabetic Chronic Kidney Disease (DCKD) is largely lacking in developing countries.We aimed to generate data in evaluating the prevalence of DCKD and associated risk factors in a selected rural community in Bangladesh.
Methods: We recruited study patients from the Mirzapur Demographic Surveillance System by stratified random sampling.We performed fasting blood sugar to screen patients for diabetes, and measured serum creatinine and urine albumin to creatinine ratio followed by a repeat measurement after 3 months to diagnose CKD.The GFR was estimated using the CKD Epidemiology Collaboration equation, and CKD was diagnosed using the Kidney Disease Outcomes Quality Initiative guidelines.Additionally, age, gender, marital status, occupation, educational background, income/month, smoking status, and sleeping hours were acquired during interviews.Physical examinations were performed to determine blood pressure, pulse rate, height, weight, waist circumference, and hip circumference.Moreover, blood samples were collected to measure serum albumin, hemoglobin, total cholesterol and triglyceride Chi-square test was performed for estimation of odds ratios (OR) and their 95% confidence intervals (CI) to determine the strength of association.Variables with P-values <0.05 were simultaneously included into the multivariate logistic model and adjusted odds ratio (aOR) and 95% CI were estimated.
Conclusions: This epidemiological data on DCKD in rural and peri-urban Bangladesh revealed a 7% prevalence of DCKD.An early detection system to diagnose DCKD and the intervention should be scaled up to curb the risk factors, such as hypertension, low serum albumin, and hypertriglyceridemia.
Funding: Private Foundation Support Background: The American Diabetes Association (ADA) and Kidney Disease Improving Global Outcomes (KDIGO) consensus recommendations advise that patients with type 2 diabetes (T2DM) undergo annual screening with urine microalbumin creatinine ratio and estimated glomerular filtration rate.Less than half of patients with T2DM receive the recommend screening.This project aimed to increase CKD screening in Spanish-Speaking patients with poorly controlled T2DM (A1c>9) by 5% over 2 months at a community health center in rural North Carolina and evaluated secondary patientcentered outcomes of initiation of sodium glucose cotransporter 2 inhibitors (SGLT2i) and diagnosis with CKD.
Methods: We performed chart review querying for Spanish-speaking patients at SCCHC with T2DM with A1c>9 without a diagnosis of CKD (n=134).We then created a pop-up alert for patients without any CKD screening in the past year.We performed patient outreach to schedule appointments, offer counseling on CKD screening, and pend labs.Finally, we generated a flier for providers summarizing ADA and KDIGO guidelines for CKD screening and initial management.
Results: Only 43% of patients received full screening at baseline.Overall, the number of patients screened for CKD increased by 7%.85% of patients with alerts in their charts who showed up for appointments received full screening.50% of patients contacted through patient outreach scheduled an appointment and all patients who were seen in clinic following outreach received full screening.Only 29% of patients for whom the only intervention was provider education recieved complete screening.No diagnoses of CKD were made as a result of screening.There was an increase in prescription of an SGLT2i from 35% to 69% in patients recieving any CKD screening.
Conclusions: The improvement in CKD screening resulting from this project supports the need for pre-visit planning tools that highlight CKD screening, for patient education efforts, and for a one click 'Kidney Profile' lab order.The increased use of SGLT2i in patients recieving full screening supports a correlation between CKD screening and increased risk reduction therapy.Future efforts to increase appropriate CKD diagnosis and patient counseling following screening will be important for empowering patients to prevent disease progression.

SA-PO453 Poster Saturday
Diabetic Kidney Disease: Clinical -II
Background: Diabetes mellitus is a major risk factor for the development of chronic kidney disease (CKD).An association between glycated hemoglobin (HbA1c) and decline of kidney function is well established.There is limited data addressing the prognostic value of baseline HbA1c to predict long-term renal outcomes regardless of diabetes status or anti-diabetic therapies.
Methods: In this single-center retrospective observational study, we analyze the effect of glycemic status on renal outcomes in a study population of N = 19,285 subjects over a median follow-up time of 69 months.The primary endpoint was defined as time to manifestation of moderate CKD (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73m 2 ) in subjects with unconstrained kidney function (eGFR > 60 ml/ min/1.73m 2 ) at baseline.The secondary endpoint was defined as time to progression of CKD (eGFR < 30 ml/min/1.73m 2 ) in subjects with CKD stage III (eGFR 30 -60 ml/min/1.73m 2 ) at baseline.Endpoints were individually analyzed using interval-and right-censored datasets.For univariate time-to-event analysis, subjects were grouped into four cohorts by median HbA1c at baseline (HbA1c: < 5.7%, 5.7 -6.5%, 6.5% -8.5%, ≥ 8.5%).Covariate-adjusted hazard ratios were estimated applying multivariate parametric regression models on continuous HbA1c measures.A Cox proportional hazard based model was established to predict decline of kidney function based on discrete baseline HbA1c levels.
Conclusions: HbA1c is a strong predictor for kidney function decline, regardless of preexisting diabetes status or CKD stage.Lower HbA1c levels are associated with a lower risk of manifestation or progression of CKD.

Figure 1 .
Figure 1.Association between air pollutants and ESRD

Screening in Spanish-Speaking Patients with Poorly Controlled Type 2 Diabetes at a Rural Community Health Center
Anna Kenan, 1 Naeemah Munir. 2 1 The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; 2 Piedmont Healthcare Inc, Siler City, NC.