Background: Evidence-based chronic kidney disease (CKD) care can slow progression and avert complications. We evaluated evidence-based care gaps for stage 3 and 4 CKD in patients with and without diabetes (DM).

Methods: All patients age 18-75 with a primary care encounter between April and October 2019 in any of 32 clinics in a large Midwestern care system were evaluated for stage 3 or 4 CKD based on laboratory evidence of GFR 15-59 ml/min/1.73 m2 on 2 consecutive tests. Using programmed algorithms they were further assessed for CKD care gaps and classified as DM or no DM.

Results: Out of 5,336 patients with stage 3 or 4 CKD, 41% had DM. Patients with DM had a mean A1C of 7.5%, mean systolic BP 134, and 28.6% had A1C ≥8%. Compared to patients without DM, those with DM were slightly older (65.6, 66.2 years, p<.001), more likely to be male (41.9%, 47.9%, p<.001), African American (6.5%, 11.9%, p<.001) and have either stage 3b (19.9%, 30.6%, p<.001) or Stage 4 CKD (5.2%, 9.4%, p<.001).

Conclusion: CKD care for those with DM is better than for those without DM for most care elements, although large care caps remain for both groups. Of note, 28% of patients with DM had an A1C over 8%, and 15.3% of patients with DM had more advanced CKD with no evidence of seeing a nephrologist in the last year. Better care delivery strategies are needed for optimal CKD management including timely nephrology consultation.


J.M. Sperl-Hillen: None. A. Crain: None. M.B. DeSilva: None. L. Chumba: None.


National Institute of Diabetes and Digestive and Kidney Diseases (R18DK118463)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at