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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
The traditional timeline for diabetic nephropathy progression spans 10-15 years, but the impact of critical illness on this trajectory remains unknown. We investigated chronic kidney disease (CKD) progression in diabetic patients following intensive care unit (ICU) admission.
We conducted a retrospective cohort study using the MIMIC-IV database (2008-2022). From 36,414 diabetic patients, we identified 4,368 adults without baseline CKD who survived ICU admission with ≥6 months follow-up. The primary outcome was time to CKD stages 3-5 (eGFR <60 mL/min/1.73m²). We categorized patients as rapid progressors (<3 years to CKD), slower progressors (≥3 years), or non-progressors.
During median follow-up of 14.64 years, 1,563 patients (35.8%) developed CKD at a median of 2.5 years (IQR 1.2-4.8), representing a 4-6 fold acceleration versus the expected timeline. Rapid progressors (n=895, 20.5%) developed CKD at a median of 0.73 years; slower progressors (n=668, 15.3%) at 6.57 years. Glucose coefficient of variation was the strongest predictor (HR 2.039, 95% CI 1.361-3.056, p=0.001), followed by age (HR 1.022 per year, p<0.001) and maximum AKI stage (HR 1.159, p=0.012). AKI occurred twice as frequently in progressors versus non-progressors (41% vs 20%, p<0.001). Risk stratification effectively separated outcomes: very high-risk patients had a median progression time of 3.472 years versus 9.807 years for high-risk and not reached for low/moderate risk groups.
Figure 1. Machine learning prediction of EPO response in CKD anemia. (A) Random Forest model performance showing 82.1% accuracy and AUC of 0.832, outperforming logistic regression. (B) Feature importance analysis identifies baseline hemoglobin as the strongest predictor (42.4%) of EPO response. (C) The distribution of EPO response categories demonstrates that 48.5% of patients showed no hemoglobin response to therapy.
ICU admission dramatically accelerates CKD progression in diabetic patients, with one-third developing CKD within 2.5 years. Glucose variability emerges as the primary modifiable risk factor. These findings support implementing systematic kidney surveillance programs for diabetic ICU survivors, particularly within the critical first 3 years.
