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Kidney Week

Abstract: SA-PO284

Transition Probabilities of Diabetic Kidney Disease (DKD) and Death in a Multi-Ethnic Asian Population

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical


  • Sabanayagam, Charumathi, Singapore Eye Research Institute, Singapore, Singapore
  • He, Feng, Singapore Eye Research Institute, Singapore, Singapore
  • Venkataraman, Kavita, National University of Singapore, Singapore, Singapore
  • Lim, Cynthia Ciwei, Singapore General Hospital, Singapore, Singapore
  • Tan, Gavin, Singapore Eye Research Institute, Singapore, Singapore

The severity and rate of progression/regression of diabetic kidney disease (DKD) are important for making clinical decisions. We examined the transitions in DKD severity stages over time in an Asian population.


We analysed 17,081 clinic visits by 6,453 Chinese, Malay and Indian adults with type 2 diabetes who attended the annual DKD screening visits in primary care clinics from 2010-2015 with death data until 2020. CKD stage transition was defined as change in estimated glomerular filtration rate (eGFR) categories: ≥60, 30-60 and <30 mL/min/1.73 m2 (corresponding to G1-G2, G3, G4-5)+ eGFR decline ≥25% from the previous visit. A multistate Markov model was used to estimate the annual transition probabilities between 4 consecutive stages (G1-G2, G3, G4-5 and death) and the expected waiting (sojourn) time in each state adjusted for risk factors including age, gender, ethnicity, duration of diabetes, HbA1c %, systolic blood pressure (SBP), LDL-cholesterol, and diabetic retinopathy (DR) status.


The median (interquartile range) follow-up duration was 2.68 (1.08-4.29) years, and most patients had at least 3 assessments. The annual transition probability from G1-2 to G3, G3 to G4-5 in the adjusted model were 1.4%, and 1.7%, and of death from each state were 2.4%, 5.9%, and 16.4%; mean sojourn time in each state were 25.15, 5.41, and 3.93 years. Probability of regression from G3 to G1-2, and G4-5 to G3 were 9.1%, and 5.6%; DKD progression was significantly associated with older age, Malay ethnicity, DR, higher levels of HbA1c and SBP, and lower LDL-cholesterol, while regression with younger age, female gender, and lower HbA1c; Death was significantly associated with older age, male gender, longer duration of diabetes, DR, and higher levels of HbA1c and LDL-cholesterol.


Progression of DKD in people with diabetes is a gradual but steady process. Surveillance and control of blood pressure, glucose, cholesterol and DR may facilitate the management of DKD.