Associated Factors of estimated Glomerular Filtration Rate in Chronic Kidney Disease Patients in Phimai Hospital, Nakhon Ratchasima Province

Abstract

            Chronic kidney disease (CKD) is a major public health concern that leads to end-stage kidney disease and significantly increases all-cause mortality. This study aimed to identify factors associated with rapid estimated glomerular filtration rate (eGFR) decline in patients with stage 3–4 CKD. An analytical retrospective case-control study was conducted among 204 patients at Phimai Hospital from October 2023 to September 2024. Subjects were equally divided into two groups of 102: the rapid eGFR decline group (≥ 5 ml/min/1.73m²/year) and the stable eGFR decline group (< 5 ml/min/1.73m²/year). Multivariable logistic regression with backward elimination was performed.

            Three independent predictors were identified: nephrotoxic drug use (Adjusted OR = 2.40; 95% CI: 1.05, 5.49), CKD stage G4 (Adjusted OR = 2.26; 95% CI: 1.24, 4.14), and macroalbuminuria ≥ 300 mg/gCr (Adjusted OR = 2.17; 95% CI: 1.19, 3.93). A dose-response relationship was observed between albuminuria and eGFR decline, with mean annual decline of 6.29 ± 6.89 vs. 3.65 ± 5.78 ml/min/1.73m²/year in macroalbuminuria and microalbuminuria groups, respectively (p = 0.001). The joint population attributable fraction of all three predictors was 63.1%, and the number needed to screen for macroalbuminuria was 4.8 patients.

            Macroalbuminuria, CKD stage G4, and nephrotoxic drug use are independent predictors of rapid kidney function decline. Incorporating risk stratification into clinical practice and actively screening for modifiable risk factors, particularly herbal medicine use, can effectively slow CKD progression.