#2661 High albuminuria in CKD: prevalence and characteristics in a real-world clinical setting

Abstract Background and Aims Chronic kidney disease (CKD) is estimated to affect 1 in 10 adults globally. CKD is associated with increased morbidity, mortality and decreased quality of life, and places a financial burden on the healthcare system. Furthermore, persistently high albuminuria is associated with an especially high risk of renal and cardiovascular complications in patients with CKD. With recent advances in therapeutic approaches for CKD management, both with sodium–glucose co-transporter-2 inhibitors (SGLT2i) and endothelin receptor antagonists as add-on to renin–angiotensin system blockade, it is important to highlight patients with persistent urine albumin-creatinine ratio (UACR; ≥700 mg/g). In patients with UACR >700 mg/g, a novel and highly selective endothelin receptor A antagonist (zibotentan) plus the SGLT2i dapagliflozin significantly reduced albuminuria versus dapagliflozin plus placebo (ZENITH-CKD trial). Hence, it is important to understand the prevalence and characteristics of patients with CKD and high albuminuria in a real-world clinical setting. Methods We used a large USA claims database (Optum's de-identified Clinformatics® Data Mart Database [CDM]) to identify patients aged ≥18 years with a CKD diagnosis and a UACR measurement ≥200 mg/g. Patients were indexed on 1st January 2022 and grouped into two UACR groups: ≥700UACR group (≥700 mg/g) and <700UACR group (200–699 mg/g). Continuous variables were calculated as medians with interquartile range (IQR). Baseline characteristics and comorbidities included age, sex, median UACR, median estimated glomerular filtration rate (eGFR) and a history of heart failure. Results Of 53,306 patients with CKD and UACR ≥200 mg/g, 22,504 (42%) were in the ≥700UACR group and 30,802 (58%) in the <700UACR group (Fig. 1). Patients were more frequently men in both groups (57%). Median UACR was 1459 mg/g (IQR 977–2473) in the ≥700UACR group and 341 mg/g (IQR 256–474) in the <700UACR group. Patients in the ≥700UACR group were slightly younger (72 vs 74 years), had a higher frequency of heart failure (42% vs 34%) and lower eGFR (37 mL/min/1.73 m2 [IQR 21–55] vs 49 mL/min/1.73 m2 [IQR 34–67]) compared to the <700UACR group. Conclusions In this contemporary study of patients with albuminuric CKD, more than 4 out of 10 had UACR levels ≥700 mg/g. These patients were slightly younger, had more severe CKD, and greater prevalence of cardiorenal disease compared to those with UACR 200–699 mg/g. Patients with UACR levels ≥700 mg/g have an urgent need for improved risk management.