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Abstract: FR-PO950

Risk Factors for Progression to Kidney Failure in Patients with CKD Stages 3B and 4 in a Singaporean Cohort

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Weng, Wanting, Tan Tock Seng Hospital, Singapore, Singapore
  • Yeo, See Cheng, Tan Tock Seng Hospital, Singapore, Singapore
  • Ooi, Xi Yan, Tan Tock Seng Hospital, Singapore, Singapore

The prevalence of chronic kidney disease (CKD) is increasing globally and the burden of kidney failure is also increasing. We aim to examine the risk factors for progression to kidney failure in patients with CKD stages 3B and 4 and develop a risk prediction model for predicting kidney failure in our local multi-ethnic population.


Demographics, clinical and laboratory data of patients with CKD stages 3B and 4 referred from polyclinics to Tan Tock Seng Hospital(TTSH) Renal Medicine between April 2017 to February 2022 were collected. The primary outcome was kidney failure defined as an estimated glomerular filtration rate (eGFR)<15ml/min/1.73m2. The secondary outcome was that of a composite of kidney failure, death, doubling of serum creatinine and eGFR decline by 40%. Multivariate cox proportional hazard regression analyses were used to evaluate risk factors for the primary outcome. A risk prediction model for predicting kidney failure was developed and performance was evaluated by C-statistic.


There were 2033 patients with CKD 3B and 4 referred from polyclinics to TTSH between 2017 to February 2022. 848 patients with less than 1 year of follow up was excluded(except if they developed kidney failure in less than 1 year, n=8). There were 1193 patients included in the analysis of which 66.3% had CKD 3B and 33.7% had CKD 4. The median age of these patients was 70.8(31.3-83.6) years old. 56.9% were males and the median eGFR was 33(IQR:15-44)ml/min/1.73m2. 73.1% of the cohort had diabetes mellitus and 93.8% had hypertension. 80.6% of patients were on an ACE inhibitor or ARB. Mean duration of follow up was 36.8 months. 6.2% of patients died and 12% developed the primary outcome. 19.6% of patients developed the secondary outcome. Higher proteinuria (HR 1.15,95%C.I 1.02-1.30) higher serum creatinine (HR 1.04, 95%C.I 1.03-1.05), higher annual rate of decline of eGFR, Malay ethnicity (HR2.13 95% C.I 1.05-4.33), higher diastolic blood pressure(HR 1.05 95%CI 1.01-1.08) and female gender were risk factors for kidney failure. The Harrell C-statistic for the final model was 0.93.


Our model for predicting kidney failure in patients with CKD stage 3B and 4 including the variables ethnicity, annual eGFR decline, baseline proteinuria and serum creatinine had a C-statistic of 0.93 and should be validated in a larger population of patients.