The prevalence of normoalbuminuric diabetic kidney disease (DKD) has increased in the past 20 years in the U.S. While previous studies reported the significance of nonalbuminurics pathway to kidney function loss in DKD, the factors associated with the nonalbuminuric kidney function decline remains to be elucidated. This study aimed to compare the CKD risk factors between nonalbuminuric and albuminuric DKD. Among NHANES participants (1999-2016) with diagnosed diabetes and reduced eGFR (< 60), we compared CKD risk factors (including demographics and CKD diagnosis status) between patients with normoalbuminuria (ACR<30) and albuminuria (ACR ≥ 30) using univariate and multivariable analyses. In our DKD cohort, there were 1479 (63%) normoalbuminuric and 1027 (37%) albuminuric cases. Risk factors that significantly differed between albuminuric statuses are presented in Table [Table]. In the multivariable model, age, gender, and DBP were not significantly associated with albuminuric status, while CKD diagnosis status was the strongest predictor followed by eGFR. Normoalbuminuria in patients with diabetes and reduced eGFR is associated with a seemingly healthier lab profile and lower odds of being diagnosed with CKD. Future studies should examine novel markers for detection of and protection against kidney function decline in nonalbuminuric DKD.


M. Mosslemi: None. R.M. Hanna: None. C. Rhee: Research Support; Self; Dexcom, Inc. K. Kalantar-Zadeh: None. E. Streja: None.

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