Factors Affecting Kidney Deterioration in Patients with Chronic Kidney Disease, Stages 3 and 4, Warin Chamrab Hospital, Ubon Ratchathani Province
Keywords:
Chronic Kidney Disease, Kidney Deterioration, Risk Factors, Glomerular Filtration RateAbstract
Background: Chronic kidney disease (CKD) is a significant public health problem in Thailand, particularly stages 3 and 4, which show a continuous increasing trend. Understanding factors affecting kidney deterioration is crucial for treatment planning.
Objective: To study factors affecting kidney deterioration in patients with chronic kidney disease stages 3 and 4 at Warin Chamrab Hospital, Ubon Ratchathani Province.
Methods: This is an analytical research design and retrospective study in the medical records of 210 patients diagnosed with chronic kidney failure, stage 3 to stage 4, who received treatment between October 2022 and October 2023. Divided into two groups according to the rate of kidney deterioration: those with a decrease in eGFR of less than 5 and greater than or equal to 5 ml/min/1.73 m² per year by studying general factors. Health factors include body mass index, comorbidities, blood pressure, anemia, hyperlipidemia, blood glucose level, use of blood glucose lowering drugs, use of ACEIs/ARBs, use of statins, and health factors occurrence of kidney impairment. Data were analyzed using descriptive statistics, including number, percentage, mean, standard deviation, and inferential statistics such as chi-square and multiple logistic regression.
Results: Factors significantly associated with kidney deterioration included diabetes mellitus (OR 2.20, 95% CI: 1.21-4.01), insulin therapy (OR 10.21, 95% CI: 5.12-20.35), blood glucose levels above 200 mg/dL (OR 3.42, 95% CI: 1.30-9.02), systolic blood pressure above 130 mmHg (OR 3.00, 95% CI: 1.59-5.66), and maximum systolic blood pressure exceeding 180 mmHg (OR 5.61, 95% CI: 2.04-15.42). Additionally, anemia with hematocrit below 30% was significantly associated with kidney deterioration (OR 4.61, 95% CI: 1.90-11.18). Regarding medication use, diuretics (OR 3.93, 95% CI: 1.60-9.65) were associated with accelerated kidney deterioration, while ACEIs and ARBs showed a protective effect against kidney deterioration (OR 0.44, 95% CI: 0.24-0.81).
Conclusion: Key factors associated with kidney deterioration were poor control of diabetes and hypertension, anemia, and certain medications, particularly diuretics. Therefore, patient care should focus on controlling these risk factors with close monitoring of high-risk patients, especially elderly patients with multiple comorbidities, to slow kidney deterioration and prevent complications.
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