Abstract: SA-PO356

Progression of CKD and Outcomes in Thailand: Thai-SEEK Project

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Chaiprasert, Amnart, Phramongkutklao Hospital, Pathumthani, Thailand
  • Kiattisunthorn, Kraiwiporn, Siriraj Medical School, Mahidol University, Bangkok, Thailand
  • Pichaiwong, Warangkana, RAJAVITHI HOSPITAL, Bangkok, Thailand
  • Ophascharoensuk, Vuddhidej, Chiang Mai University, Chiang Mai, Thailand
  • Trakarnvanich, Thananda, Vajira Hospital, Bangkok, Thailand
  • Sirivong, Dhawee, Faculty of Medicine Khon Kaen University, Khon Kaen, Thailand
  • Ingsathit, Atiporn, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Group or Team Name

  • Thai-SEEK Steering Committee, Nephrology Society of Thailand
Background

Chronic kidney disease (CKD) is one of the major public health problems, however, the data of CKD in Thai population including prevalence and progression, also its outcomes are limited. In 2008, Thai-SEEK (Screening and Early Evaluation of Kidney Disease) study, a community-based cross-sectional study using stratified-cluster sampling method, was initiated which found prevalence of CKD for 17.5%. Therefore, the study was conducted to evaluate the progression and outcomes as well as predicting factors of CKD in Thailand.

Methods

A prospective cohort study was run from June 16, 2015 to December 15, 2016 by using subjects of the first survey. Data from history taking and physical examination, serum creatinine, urinalysis, and urine albumin creatinine ratio were done in 2,396 subjects (70%) who gave responses for participating follow up program, and death certificates were used to identify causes of death. Four hundred and eight subjects (68% of those diagnosed CKD in the first survey) were analyzed for CKD progression and outcomes. Serum creatinine standardized with SRM967a (National Institute of Standards and Technology, MD, USA) was put in GFR calculation using CKD-EPI formula. Staging of CKD was based on KDIGO 2012 criteria, and rapid CKD progression was defined as a change in CKD staging plus a decline in GFR >25% or >5 ml/min/1.73m2/year or renal replacement therapy was initiated.

Results

Mean age was 54.6+13.7 years and 41% was male. Median follow-up time was 7.9 years (min, max 7.7, 9.1). Incidence of CKD progression was 0.23 (95% CI: 0.19, 0.28) with a decline in GFR 1.40+1.13, 1.95+1.66, 1.59+1.25, 1.66+1.18 and 1.60+0.77 ml./min/1.73 m2/year in CKD stage G1, G2, G3a, G3b and G4, respectively. Predictors of progression were diabetes mellitus (RR 1.39; 95% CI: 0.09, 2.14) and hyperuricemia (RR 1.70; 95% CI: 1.17, 2.47). Mortality rate was 6% per year and associated severity of CKD staging at diagnosis. The most common cause of death was cancer (22%), following by cardiovascular disease (19.8%) and infection (12.8%).

Conclusion

During 8-year follow up, risk of CKD progression was 23%. Diabetes mellitus and hyperuricemia were the strong predictors of progression. The population based cohort would be a significant contributor in national policy making for slow CKD progression in Thailand.

Funding

  • Commercial Support