#3875 assessing the 3-year risk of 40% egfr decline or kidney failure in the us population

Abstract Background and Aims Prognostication of CKD progression currently relies exclusively on eGFR and albuminuria and do not consider comorbid conditions. Recently, the Chronic Kidney Disease Prognosis Consortium (CKD-PC) equation was developed to predict the 3-year risk of 40% eGFR decline or kidney failure in the general population [1]. The goal of our study was to assess the distribution of this risk in the US population. Method We included US adults from the 1999-2020 United States National Health and Nutrition Examination Survey (NHANES; N = 51,699). We calculated eGFR using the CKD-EPI 2021 equation and the 3-year risk of 40% eGFR decline or kidney failure using the CKD-PC equation (3-year risk). We categorized the 3-year risk as <1%, 1%-<5%, 5%-<10%, ≥10% and compared this with the current KDIGO 2012 CKD staging (eGFR<60 mL/min/1.73 m2 or albuminuria≥30 mg/g). Results Among 199.8 million US adults, mean age was 46±15 years, 51% were female, 11% were non-Hispanic Black persons, and mean BMI was 29±6 kg/m2. 71 million (36%) had hypertension and 26 million (13%) had diabetes. Table 1 shows the distribution of 3-year risk across stages of eGFR and albuminuria. Among 26 million US adults with CKD, the 3-year risks were <1% in 4 million (15%), 1% to <5% in 15 million (56%), 5 to <10% in 4 million (17%), and ≥10% in 3 million (11%). Importantly, among persons without CKD by current criteria, 1 million persons (0.58%) had a ≥5% 3-year risk, whereas only 331,840 (6%) persons with CKD 3a A1 had a ≥5% 3-year risk of CKD progression or kidney failure. Conclusion Calculating the 3-year risk of a 40% decline in eGFR or kidney failure can identify at-risk persons beyond the current eGFR and albuminuria staging. Our findings highlight the importance of factors besides eGFR and albuminuria in considering the risk for CKD progression.