Differences in chronic kidney disease management in patients with and without diabetes in a large care delivery system [abstract]
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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.