Kamarudin, Muhammad Imran
(2018)
The rate and associated factors for GFR decline among chronic kidney disease stage 3 patients in HUSM : a retrospective study.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction: The number of patients diagnosed with Chronic Kidney Disease (CKD)
has steadily; other than affecting the health of the individuals, the impact of the disease
can also be seen in the national economy as the cost for management and treatment of
progressive CKD, in particular end stage renal failure (ESRD) is highly disproportionate
to the population of affected patients. Due to the nature of the illness, there is an
increased need to detect and manage the CKD at earlier stage of the disease such as
CKD stage 3. Hence, identifications of relevant risk factors for Glomerular Filtration
Rate (GFR) decline among CKD stage 3 has become the paramount objective of this
research endeavour. Methodology: This is a retrospective cohort study involving a
review of the medical records and blood investigation result of 142 chronic kidney
disease patients in Hospital USM (HUSM) that was diagnosed with CKD stage 3 from
1st January 2008 to 31st December 2016. Other relevant details such as age, gender,
aetiology of CKD, HbA1c level, Systolic blood pressure, Serum albumin level, presence
of proteinuria and usage of angiotensin-converting enzyme inhibitors (ACEI)/
angiotensin receptor blockers (ARB) were also collected. The association factors with
GFR rate changes were analysed using linear and multiple linear regressions. Level of
significance was fixed at 0.05. Results: The rate of GFR decline per year among CKD
stage 3 is 2.77 mL/min/1.73m2/year. Within 3 year observation, 66.19% of the
participants were stable disease (≤ 24.9% GFR reduction) and 33.81% were progressive
disease ( ≥ 25% GFR reduction). Predominantly most CKD stage 3 patient remained instage 3 (80.3%) after 3 year, while small numbers progressed to stage 4 (18.3%) and
stage 5 (1.4%). There are four factors that were identified from the multiple linear
regression analysis that help predicted GFR changes in CKD stage 3; age (0.33 [95% CI:
0.17, 0.49], p value = <0.001), gender (-4.48[95% CI: -7.43,-1.52], p value = 0.003),
serum albumin year 3(0.53 [95% CI: 015, 0.90] p value 0.006), usage of ACEI/ARB (-
4.51[95% CI: -8.00, -1.03], p value 0.012). Conclusion: The rate GFR decline per year
in CKD stage 3 are comparable with other studies and predominantly the participant
remained in CKD stage 3 and more than half have stable disease. Older age is the
predominant factor in slower GFR rate decline in CKD stage 3, while normal serum
albumin associated with better GFR rate decline compared to low serum albumin.
Interestingly, female gender in our study however, was associated with faster GFR rate
decline compared to male gender. The usage of ACEI/ARB statistically had shown to
have a negative effect on GFR among our participant but there are possible uncountable
factors affecting this result, thus need to treat it with caution.
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