Predictors of rapid eGFR decline in early to moderate chronic kidney disease (stages G1–G4): insights from a real-world Thai cohort incorporating KDIGO 2024 guidelines

Many studies have identified risk factors for kidney failure; however, few have incorporated guideline-based recommendations or evaluated risk across all stages of CKD. This study aimed to identify factors associated with rapid eGFR decline in CKD stages G1-G4 using real-world clinical data. This retrospective cohort study included 2,157 patients with CKD stages 1-4 between January 2018 and December 2022. Rapid eGFR decline was defined as an average eGFR reduction of ≥5 mL/min/1.73 m²/year. Clinical variables including age, sex, BMI, diabetes mellitus (DM), hypertension, albuminuria, hemoglobin, systolic blood pressure (SBP), and use of RAASi, GLP-1RA, SGLT2i, and statins were assessed. Multivariable logistic regression was performed to identify independent predictors. Among 2,157 patients, 527 (24.4%) were classified as having rapid eGFR decline. Factors independently associated with rapid decline included SBP ≥120 mmHg (OR 1.84, <i>p</i> = 0.001), hemoglobin <10 g/dL (OR 1.78, <i>p</i> = 0.002), DM (OR 1.80, <i>p</i> < 0.001), and moderately increased albuminuria (OR 1.88, <i>p</i> = 0.002); severely increased albuminuria (OR 1.63, <i>p</i> = 0.02). In contrast, being in moderate to severe CKD stages (G3-G4) was associated with a lower risk of rapid progression (G3: OR 0.62, <i>p</i> = 0.010; G4: OR 0.59, <i>p</i> = 0.02). Statin use was also associated with a reduced risk of rapid eGFR decline (OR 0.77, <i>p</i> = 0.04). In conclusion, this study identified SBP control, anemia, DM, albuminuria and stage of CKD as key factors associated with rapid CKD progression. Achieving SBP <120 mmHg demonstrated renal benefits. Interestingly, statin use was also associated with a reduced risk of rapid eGFR decline.