1034-P: Association between Estimated Glomerular Filtration Rate (eGFR) and Proteinuria (UP) to Predict Risk of Start of Dialysis in People with and without Diabetes (DM) Free

Although UP is a very important feature of diabetic nephropathy, decreased eGFR without UP has become phenotypic of renal complications of DM in the new definition of DKD. Although both UP and reduced eGFR are strong predictors of kidney disease, only a few studies have examined the association between these two variables and risk of dialysis in the same cohort that included people with and without DM. We analyzed data from a nationwide claims database involving 335,778 participants (DM 20,223, non-DM 315,555) during 2008-16. Multivariate Cox regression model identified risks of starting dialysis. HRs were compared among 8 groups of combinations of DM+/-, UP (-, ≥+) and eGFR (<60, ≥60). Compared with eGFR ≥60, HRs for starting dialysis in those with eGFR <60 in DM- and DM+ were 14.5 (10.3-20.6) and 15.7 (10.8-22.9), respectively. In comparison with UP (-), HRs for starting dialysis with UP (≥+) in DM- and DM+ were 8.00 (5.85-11.0) and 8.01 (5.45-11.8), respectively. In DM-, compared with UP(-)eGFR ≥60, the HRs for UP(≥+)eGFR ≥60, UP(-)eGFR <60 and UP(≥+)eGFR <60 were 1.19 (0.55-2.60), 4.21 (2.47-7.17) and 113.4 (77.9-165.0), respectively. In DM+, those values were 3.83 (2.15-6.83), 6.47 (3.33-12.6) and 94.4 (58.5-152.4), respectively. In comparison with DM(-)UP(-)eGFR ≥60, risks of starting dialysis for DM(+)UP(≥+)eGFR ≥60, DM(+)UP(-)eGFR <60 and DM(+)UP(≥+)eGFR <60 significantly increased 17.7 (10.6-29.7), 25.5 (13.8-47.1) and 358.1 times (239.1-536.5), respectively.

In summary, both eGFR<60 and UP(≥+) were independent predictors for starting dialysis regardless of DM and they exhibited a synergistic risk of dialysis. Both eGFR<60 and UP(+) present an extremely high risk for dialysis especially in DM. These results may be helpful in considering the relationship between the need for strict therapeutic interventions for eGFR and UP and the risk of dialysis, according to the presence or absence of DM.