The Usefulness of Calcium/Magnesium Ratio in the Risk Stratification of Early Onset of Renal Replacement Therapy

DKD) is one of the major causes of end-stage renal diseases (ESRD)

Methods: In a prospective, observational cohort study, 392 Japanese patients with T2D and baseline eGFR ≥ 60 ml/min/1.73m 2 were followed over one year (mean period 5.5 years; IQR 3.9 -7.3).Linear regression was used to estimate participants' annual decline rate in eGFR over time.We defined subjects with an annual eGFR decline ≥ 5% per year as rapid decliner and the eGFR decline < 5% as slow decliner.Of the 392 participants, 218 patients were randomly selected and baseline levels of 75 urinary proteins were measured by multiple reaction monitoring (MRM) analysis.

Results:
The study population had a median age of 59.0 years (IQR, 56.3 -58.5) and 78.0% were male.The median duration of diabetes was 10.0 years (IQR, 9.8 -12.0).During the follow-up period, 44 patients had a rapid decline in eGFR.Median eGFR decline was -6.51% (IQR, -8.54 --6.47) and -1.29% (IQR, -1.43 --0.65) per year in rapid decliner and slow decliner, respectively.Compared with slow decliner, rapid decliner had higher HbA1c level and lower levels of HDL-cholesterol (HDL-c), Hb, and Hct at baseline, however, their differences were not significant.In the MRM analysis, we found that 11 urinary proteins were differentially excreted in rapid decliner compared to the urinary proteins of slow decliner (P < 0.05).Multivariable logistic regression models revealed that 4 urinary proteins and Hb were independent predictors of annual decline in eGFR adjusted by age, HbA1c, HDL-c, eGFR, and urinary albumin-to-creatinine ratio (P < 0.005).When combining the 4 urinary protein levels, an area under the ROC curve for the detection of rapid decliner was 0.781 (95% CI 0.709 -0.852).
Conclusions: Our findings highlight the important effect of 4 urinary proteins as independent predictors of a rapid decline in eGFR in patients with T2D and preserved kidney function.
Background: While it is well-established that T2D is the leading cause of CKD, contemporary data describing the burden of CKD among patients with both T2D and CKD is scarce.We described 3 mutually exclusive patient cohorts: T2D only, CKD with T2D, CKD without T2D in the real-world setting.
Methods: This cross-sectional study utilized 3 calendar years (2017-2019) of administrative claims data from the HealthCore Integrated Research Database.Adults diagnosed with CKD with and without T2D (CKD in T2D and CKD, respectively) and T2D without CKD (T2D) in 2018 were identified.Index date was defined as the first claim with a diagnosis for either CKD or T2D in 2018.Eligible patients were required to have continuous health plan enrollment ≥1 year pre-and post-index.Clinical characteristics, comorbidity burden (as measured by the Quan-Charlson Comorbidity Index (QCI)) and hospitalizations were analyzed descriptively.
Conclusions: CKD in T2D was associated with substantial overall and cardiovascular comorbidity burden in this contemporary real-world cohort, followed by CKD and then by T2D patients.Treatment strategies for CKD in T2D should consider the patient's individual comorbidity burden to reduce risk of cardiovascular and overall morbidity and mortality.
Funding: Commercial Support -Bayer US

PO0790 Poster
Dialysis Care: Epidemiology and the Patient Experience The Usefulness of Calcium/Magnesium Ratio in the Risk Stratification of Early Onset of Renal Replacement Therapy Rita S. Afonso, Ana Cabrita, Ana P. Silva.Centro Hospitalar do Algarve EPE, Faro, Portugal.
Background: Recently, a growing number of studies have reported a close relationship between high serum calcium (Ca) and low serum magnesium (Mg) with vascular calcification.Endothelial dysfunction and vascular inflammation seem plausible risk factors for enhanced progression of kidney disease.The aim of this study is to evaluate the role of calcium/magnesium ratio as risk factor in CKD progression.
Methods: Observational, prospective study involving 693 patients (female=371) with stage 4/5 CKD.Patients were divided into two groups, according to the development of ESRD: G1 (n=541), who did not start renal replacement therapy (RRT) and G2 (n=152), who had started RRT.Several laboratory parameters were measured.Baseline characteristics were recorded and compared.Multivariate Cox regression analysis was used to identify independent factors associated with RRT initiation.A modified Poisson regression with robust error variance was used to estimate the cumulative relative risk for RRT initiation.
Conclusions: Our results suggest that the calcium/magnesium ratio is an independent predictive factor for the initiation of RRT.Further studies are required to validate the use of this novel marker as predictor of CKD progression.