Annual eGFR decline based on albuminuria status in patients with DM, hypertension and eGFR≥60ml/min/1.73m2

Introduction:In patients with eGFR≥60,CKD is defined by presence of 2 albuminuria(UACR),obtained at least 3 months apart. Often,due to clinical stability and limited clinic resources, most patients have 1 UACR done annually, potentially delaying CKD diagnosis and treatment. We postulate that one UACR reading in DM and hypertensive patients at risk for development of CKD, could impact the progression of CKD. Our study aims to determine the eGFR decline in patients with 1 UACR reading at baseline compared to those who meets the traditional criteria for CKD of 2 readings.

METHODS:In this retrospective cohort study, we included patients with DM or hypertension, eGFR≥60, from 9 polyclinics between 2010-2014. UACR results were obtained for up to 2 years prior to study period,and patients were stratified into 3groups(Gp) – Gp1:normal UACR; Gp2: 1 abnormal ACR; Gp3: 2 abnormal UACR at least 90 days apart. The patients were followed up for 2 years and eGFR decline were compared and adjusted for age, ethnicity, HbA1c, blood pressure.

RESULTS:Of 11,783 patients in the study, 85.4% have DM. Baseline parameters between the groups were similar. Malay patients with DM was found to have a greater eGFR decline consistent with previous reports. Unadjusted eGFR decline when stratified by DM status,was greater for those with positive UACR. eGFR decline was similar between Gp 2 and 3,especially in DM patients. In the multivariate analysis with Gp 1 as reference, eGFR decline was similar between Gp 2 and 3 in diabetic patients,but higher in Gp 3 in hypertensive patients.

CONCLUSION: In diabetic and hypertensive patients with eGFR≥60,albuminuria was associated with greater eGFR decline. eGFR decline was similar regardless of 1 or 2 UACR results,especially in patients with DM. This suggests that treatment should be considered with a single albuminuria result before a second reading is needed to meet the CKD definition.