Risk Factors for Progression from Stage 3 to Stage 4 Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus at Phimai Hospital, Nakhon Ratchasima Province: A Retrospective Cohort Study

Abstract

The objectives of this retrospective cohort study were to examine incidence of chronic kidney disease (CKD) progression and identify risk factors associated with the progression from stage 3 to stage 4 of CKD in type 2 diabetes patients at Phimai hospital, Nakhon Ratchasima province. Samples were 375 patients randomized from the medical records. Data were analyzed using descriptive statistics and inferential statistics with a linear model, setting the dependent variable with a binomial distribution and a logarithmic link function. Results were presented in exponentiated form, yielding coefficients as risk ratios (RR), adjusted for confounding variables, with adjusted risk ratios (RR_adj), 95% confidence intervals (95%CI) with p-values of 0.05 significance level.

The incidence of stage 4 CKD was 13.07% (95%CI=10.03-16.86). After controlling for blood glucose levels, glycated hemoglobin, HDL, and hypoglycemic meds, significant risk factors for progression from stage 3 to stage 4 CKD were: 1) age over 70 years, 1.16 times increased risk (RR_adj=1.16, 95%CI=1.05-1.32); 2) HDL<40 mg%, 1.26 times increased risk (RR_adj=1.26, 95% CI=1.12-1.41); 3) Microalbumin≥30 mg/g, 1.43 times increased risk (RR_adj=1.43, 95% CI=1.25-1.61); 4) SBP≥140 mmHg, 1.22 times increased risk (RR_adj=1.22, 95%CI=0.99-1.35); and 5) DBP<90 mmHg, 1.47 times increased risk (RR_adj=1.47, 95%CI=1.24-1.76). From the findings, kidney clinics should develop participatory care models to reduce the risks of progression to stage 4 CKD and to monitor high-risk patients with CKD.