Abstract 13951: Change in Albuminuria Measured by Urine Albumin-to-Creatinine Ratio (UACR) and Associated Clinical Outcomes in Patients With Chronic Kidney Disease (CKD) Associated With Type 2 Diabetes (T2D)
Bibliographic record
Abstract
Introduction: The impact of change in albuminuria measured by UACR on key clinical outcomes (overall survival [OS], a composite cardiovascular [CV] outcome, and kidney disease progression) in patients (pts) with CKD associated with T2D is understudied. Hypothesis: A decreased UACR is associated with a lower risk of clinical outcomes, while an increased UACR is associated with a higher risk of clinical outcomes. Methods: Adult pts with an elevated UACR ≥30 mg/g (initial test) after T2D and CKD diagnosis were identified from the Optum EHR database (1/2007-9/2021). UACR change was categorized as increased (>30% change), stable (-30% to 30%), or decreased (<-30%) based on the percentage change between the initial test and the last test (between 6 to 24 months after the initial test). Clinical outcomes, including OS, a composite CV outcome (CV death, myocardial infarction, stroke, or heart failure hospitalization), and kidney disease progression (≥40% eGFR decline or kidney failure) were evaluated after the last UACR test using Kaplan-Meier analysis. Hazard ratios (HR) of clinical outcomes for UACR change were estimated using Cox proportional hazard models adjusting for baseline characteristics. Results: Among 160,382 pts (median follow-up: 2.9 years), 89,562 had decreased UACR, 35,117 had stable UACR, and 35,703 had increased UACR. Compared with pts with stable UACR, pts with decreased UACR had significantly lower risks for all clinical outcomes (Figure) with adjusted HR of 0.93 for OS, 0.93 for the composite CV outcome, and 0.84 for kidney disease progression, while pts with increased UACR had significantly higher risks for OS (HR=1.24), the composite CV outcome (HR=1.24), and kidney disease progression (HR=1.41). Conclusions: In pts with CKD associated with T2D, >30% UACR decrease was associated with a lower long-term risk of overall mortality, CV events, and kidney disease progression. These findings highlight the importance of albuminuria monitoring in these pts.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".