Factors associated with rapid decline in kidney function among stage 5 CKD patients at Chomthong Hospital
Keywords:
rapid progression in stage 5 CKD, dialysis initiation, Chomthong Hospital, eGFR, urinary protein excretionAbstract
Introduction: Currently, the main issue for patients with end stage kidney disease is the lack of appropriate planning due to an unknown timeline and factors influencing rapid initiation of renal replacement therapy (RRT).
Objective: To investigate the factors associated with rapid progression in stage 5 CKD and the factors related to initiation of RRT within 12 months.
Methodology: This retrospective study involved patients with stage 5 CKD who received renal replacement therapy, using electronic hospital data from Chom Thong Hospital from 2014 to 2024. Data collection to assess the annual decline rate of renal filtration, the time from diagnosis to initiation of renal replacement therapy (RRT), and associated factors. Multivariable logistic regression analysis was used to identify factors associated with rapid CKD progression. Adjusted odds ratios (Adj. OR) and 95% confidence intervals were reported.
Results: A total of 146 eligible patients were included, with a mean age of 57.8 ±13.23 years , and 43.15% were female. The mean eGFR was 11.63 ± 2.69 mL/min/1.73 m². The average annual decline in eGFR was 7.42 ± 6.02 mL/min/1.73 m², and the median time from diagnosis to RRT initiation was 15 months (IQR 15, min 3 – max 11). The most common causes of CKD were diabetes mellitus (39.7%) and hypertension (15.8%). Factors associated with rapid progression of CKD included urinary protein excretion ≥4 g/day (Adjusted OR 6.67, 95% CI 2.02–22.05, p = 0.002). Factors associated with initiation of RRT within 12 months were eGFR <12 mL/min/1.73 m² (Adjusted OR 2.96, 95% CI 1.31–6.68, p = 0.009) and urinary protein excretion ≥4 g/day (Adjusted OR 8.45, 95% CI 3.28–21.80, p < 0.001).
Conclusion: Patients with stage 5 CKD at Chom Thong Hospital experienced a relatively rapid decline in kidney function. High levels of proteinuria and low baseline eGFR were significantly associated with earlier initiation of renal replacement therapy.
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