Incidence, Event-Free Survival, and Factors Associated with the Occurrence of Chronic Kidney Disease in Patients with Type 2 Diabetes in Phon Na Kaew District, Sakon Nakhon Province

Abstract

            This retrospective cohort study aimed to investigate the incidence, event-free survival, and factors associated with the development of chronic kidney disease (CKD) among patients with type 2 diabetes mellitus in Phon Na Kaeo District, Sakon Nakhon Province. The study population consisted of 519 newly diagnosed type 2 diabetes patients between January 1, 2013, and December 31, 2019, who were followed up until December 31, 2023. Data were retrospectively collected from medical records using standardized abstraction forms. Survival analysis and Cox proportional hazards regression with a backward elimination approach were employed. The significance level was set at 0.05.

            Results showed a CKD incidence of 7.04 per 1,000 person-months (95% CI: 6.23, 7.95), with a median event-free survival of 91.41 months (95% CI: 82.03, 105.31). Significant risk factors included HbA1c ≥7% (Adjusted HR =4.77; 95% CI: 3.01, 7.56), HDL <40 mg/dL (Adjusted HR =1.67; 95% CI: 1.30, 2.16), NSAID use (Adjusted HR =2.11; 95% CI: 1.63, 2.73), smoking (Adjusted HR =2.05; 95% CI: 1.45, 2.88), and allopurinol use (Adjusted HR =5.83; 95% CI: 2.74, 12.38). In contrast, the use of losartan was associated with an 80% reduced risk of CKD (Adjusted HR=0.20; 95% CI: 0.09, 0.45).

            The research findings indicate a need to focus on controlling HbA1c levels to be below 7%, promoting smoking cessation, considering a reduction in the use of NSAIDs, and closely monitoring patients on Allopurinol. Additionally, the use of Losartan should be considered in diabetic patients at high risk for chronic kidney disease to delay the onset of renal complications.