Risk factors for progression in Asians with early-stage CKD identified in study

Underlying medical conditions, albuminuria, ethnicity, lifestyle, and medication all factor into the risk of progression in a multiethnic Asian population of patients with early-stage chronic kidney disease (CKD), as shown in a study from Singapore.

The major factors positively associated with progression were diabetes (odds ratio [OR], 2.59, 95 percent confidence interval [CI], 2.18–3.09), hypertension (OR, 1.69, 95 percent CI, 1.18–2.41), worsening albuminuria stage (A2: OR, 1.41, 95 percent CI, 1.18–1.70; A3: OR, 4.19, 95 percent CI, 3.45–5.10), Malay ethnicity (OR, 1.52, 95 percent CI, 1.35–1.72), active smoking (OR, 1.26, 95 percent CI, 1.09–1.47), and being on maximum doses of ACE inhibitors/ARBs at baseline (OR, 1.28, 95 percent CI, 1.07–1.53). [Front Med (Lausanne) 2025;12:1526596]

Protective associations were observed for increasing age (OR, 0.991, 95 percent CI, 0.984–0.998), higher baseline eGFR (OR, 0.968, 95 percent CI, 0.965–0.972), higher diastolic blood pressure (OR, 0.989, 95 percent CI, 0.983–0.995), and BMI (OR, 0.981, 95 percent CI, 0.971–0.991).

The analysis included a total of 19,274 early-stage CKD patients (mean age 62.27 years, 54.4 percent male, 70.4 percent Chinese) from the HALT-CKD program. Of these, 1,992 (10.3 percent) (mean age 63.5 years, 55 percent male, 65.2 percent Chinese) experienced progression. 

Malays at risk

The findings indicate that ethnicity is a significant factor for progression among individuals with early-stage CKD, with Malays facing the highest risk, according to the investigators. This is consistent with other local CKD studies showing Malays to have a higher likelihood of developing CKD, experience a more rapid progression to end-stage renal disease, and have a disproportionately higher number of new CKD cases compared with other ethnic groups. [Nephron 2018;138:202-213; Diabet Med 2016;33:332-339; BMJ Open Diabetes Res Care 2021;9:e002364]

In the study, Malays were more likely to be active or ex-smokers (28.3 percent) compared with Chinese (23 percent), Indians (22.9 percent), and others (26.8 percent). More Malays had stage A3 albuminuria status at baseline (18.2 percent vs 13.6 percent, 12.4 percent, and 16.8 percent, respectively). Furthermore, the BMI of Malays was the highest among all ethnic groups (mean, 30.26 vs 26.40, 27.90, and 29.19 kg/m², respectively).

Why Malays are particularly vulnerable to CKD progression could be a mix of factors, the investigators noted. This could be influenced by varying health beliefs, different levels of socioeconomic status, and how well people engage with the health system, they added.

Gap in research

“In general, findings from this study align well with established risk factors for CKD progression,” the investigators said.

However, most of the existing research on CKD, including systematic reviews, focus on patients with moderate to advanced CKD, they noted. “Similarly, risk prediction tools for CKD such as the Kidney Failure Risk Equation, which predicts the risk of end stage kidney disease, is only validated for use in those with CKD stages G3–G5 and not the earlier stages.” [BMC Nephrol 2019;20:451; JAMA 2011;305:1553-1559]

Some efforts have been made to develop risk prediction models for early-stage CKD and its progression, but they often focus on the diabetic population, which limits the models’ general use, they said. [Int J Environ Res Public Health 2020;17:4973; Diabetes Res Clin Pract 2017;123:49-54; Front Nephrol 2024;3:1237804; NPJ Digital Med 2024;7:140]

The investigators underscored the need for more research on early-stage CKD, as healthcare shifts its focus toward preventing diseases at the population level. The resulting data from this research would help to develop better strategies for upstream management of the disease, they added.