Incidence and factors associated with rapid decline in glomerular filtration rate among well-controlled diabetic patients with declining kidney function at Nakornping Hospital
Keywords:
well-controlled diabetes mellitus, rapid eGFR decline, aging, high systolic blood pressure, anemiaAbstract
Introduction: Diabetes mellitus can lead to rapid decline in renal function despite adequate glycemic control. However, information concerning the incidence and determinants of rapid estimated glomerular filtration rate (eGFR) decline in these patients in Thailand remain limited.
Objective: To explore the incidence and factors associated with rapid eGFR decline among patients with well controlled diabetes mellitus with decline of eGFR at Nakornping Hospital.
Methods: This retrospective cohort study utilized electronic medical records and laboratory databases from Nakornping hospital. This study included diabetic patients aged ≥ 35 years with HbA1c <7% and at least two eGFR measurements at least 1 year apart that showed a downward trend between October 1, 2020, and December 31, 2024. Rapid eGFR decline was defined as a decrease in eGFR of more than 5 ml/min/1.73 m² per year, according to KDIGO 2012. Incidence rates per 100 person years were calculated, and data were analyzed using descriptive statistics and multivariable logistic regression.
Results: Among 375 diabetic patients with well-controlled glycemia and declining eGFR, 293 were identified with rapid eGFR decline (median age 66 years, IQR 59–72; 50.17% female), while 82 were in the non-rapid decline group (median age 62 years, IQR 56–69; 59.76% female). The incidence rate of rapid eGFR decline was 59.1 per 100 person-years (95% CI: 52.7–66.3), with a median follow-up duration of 1.3 years (IQR 1.1–1.6). Multivariable analysis revealed that age ≥ 60 years (aOR 2.23; 95% CI 1.26–3.96) and systolic blood pressure ≥140 mmHg (aOR 1.84; 95% CI 1.01–3.34) were significantly associated with rapid eGFR decline. Conversely, higher hemoglobin and HDL cholesterol levels served as protective factors against rapid eGFR decline (aOR 0.83; 95% CI 0.70–0.99 and aOR 0.97; 95% CI 0.95–0.99, respectively).
Conclusion: Diabetic patients with well-controlled glycemia still exhibited a high incidence rate of rapid eGFR decline, particularly among the elderly and those with high systolic blood pressure. The results of this study confirm the importance of blood pressure control, as well as the management of anemia and HDL cholesterol levels, in conjunction with glycemic control for maximum efficacy in slowing the progression of kidney function decline in this patient group.
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