Risk factors associated with rapid progression of chronic kidney disease. A retrospective cohort study.

Objective: To evaluate the association of various risk factors with rapid progression of chronic kidney disease. Methods: This retrospective study was conducted in CKD patients admitted in a tertiary care hospital between January 2018 to December 2020 with a minimum follow up of one year. Variables including age, sex, hemoglobin, uric acid, serum creatinine, eGFR, proteinuria, presence of AKI and other comorbidities were recorded at baseline. The primary outcome was association of various risk factors with rapid progression of CKD (sustained decline in eGFR of more than 5 ml/min/1.73 m2 /yr.). Each potential risk factor was first evaluated using univariate logistic regression with rapid CKD progression as the dependent variable. Variables with p<0.2 and clinically important variables were taken for multivariate analysis to identify independent predictors. Results: A total of 993 patients were included in study. Of these 442 (43.5%) were having rapid progression of CKD. Risk factors independently associated with rapid progression of CKD included presence of AKI (OR=1.589, CI= 1.092-2.311, p=0.015), baseline eGFR (OR=1.043, CI= 1.031-1.054, <0.01) and anemia (OR=1.805, CI= 1.178-2.766, p=0.007). Additionally, HbA1c (OR= 1.035, P=0.383), hypertension (OR= 1.258, P= 0.352), proteinuria (OR= 1.242, P= 0.243) and retinopathy (OR= 1.234, P= 0.291) showed a higher odd of rapid CKD progression in multivariable analysis, but the associations did not reach statistical significance. Conclusion: This study identified presence of AKI, level of baseline eGFR and anemia as risk factors significantly associated with rapid CKD progression.