ArticleFrontiers in medicine2025
Factors affecting disease progression in early-stage chronic kidney disease in a multi-ethnic, southeast Asian primary care population.
Article in Frontiers in medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: While effective risk factor control and medication optimization in early-stage CKD can significantly slow disease progression, a paucity of studies hinders comprehensive understanding. This study aims to identify factors associated with progression of early-stage CKD in primary care. Methods: We retrospectively analyzed data of CKD G1-G2 patients with type 2 diabetes or hypertension, recruited from an ongoing cohort between 2017 and 2023 from six polyclinics in Singapore. The outcome of interest was CKD progression, defined as a 25% decline in eGFR from baseline and worsening of CKD stage. Multivariable logistic regression was used to analyze the factors associated with CKD progression among early-stage CKD patients. Results: Among 19,274 patients analyzed, CKD progression occurred in 1,992 patients (10.3%). Patients had a mean age of 62.27 years (SD 9.54), 54.4% were male, 70.4% Chinese, 18.1% Malay, 8.2% Indian, and 3.4% Others. On multivariable analysis, factors associated with CKD progression include Malay ethnicity (OR: 1.52, 95% CI: 1.35, 1.72), A2 (OR: 1.41, 95% CI: 1.18, 1.70) and A3 albuminuria (OR: 4.19, 95% CI: 3.45, 5.10), diabetes (OR: 2.59, 95% CI: 2.18, 3.09), hypertension (OR: 1.69, 95% CI: 1.18, 2.41), increasing systolic BP (OR: 1.005, 95% CI 1.001, 1.008), active smoking (OR: 1.26, 95% CI: 1.09, 1.47), being on maximum doses of ACE inhibitors/ARBs at baseline (OR: 1.28, 95% CI 1.07, 1.53) and having undergone CKD counseling (OR: 1.84, 95% CI 1.59, 2.12). Increasing age (OR: 0.991, 95% CI 0.984, 0.998), higher baseline eGFR (OR: 0.968, 95% CI 0.965, 0.972), higher diastolic BP (OR: 0.989, 95% CI 0.983, 0.995), and BMI (OR: 0.981, 95% CI 0.971, 0.991) significantly reduced odds of CKD progression. Conclusion: This study identified key factors associated with early-stage CKD progression in a multi-ethnic Asian population. Further research is also needed to address benefits of patient counseling and SGLT2i use. Refining risk stratification methods will enable targeted interventions and improve outcomes for high-risk CKD patients.
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