Rate of eGFR Decline and Factors Associated with Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease Stage G2-G3a: A Retrospective Cohort Study at Phayao Hospital

Abstract

This retrospective cohort study aimed to determine the rate of change in estimated glomerular filtration rate (eGFR slope) and factors associated with chronic kidney disease progression among patients with type 2 diabetes mellitus and CKD stages G2–G3a at Phayao Hospital. Electronic medical records from June 1, 2023 to May 31, 2026 were reviewed. Eligible patients were aged ≥18 years, had a baseline eGFR of 45–89 mL/min/1.73 m², at least three eGFR measurements, and a minimum follow-up duration of 24 months. Individual eGFR slopes were calculated using linear regression, and associated factors were examined using simple and multiple linear regression.

Among 7,784 patients with encounters during the study period, 1,427 met the eligibility criteria and were included in the analysis. Of these, 784 (54.9%) were female, with a mean age of 66.66±8.44 years and a mean baseline eGFR of 69.98±12.42 mL/min/1.73 m². Median follow-up was 2.51 years (IQR 2.34–2.66). CKD stages G2 and G3a accounted for 1,067 (74.8%) and 360 (25.2%) patients, respectively. The mean eGFR slope was −6.21±5.00 mL/min/1.73 m²/year, and 58.5% of patients had an eGFR decline exceeding 5 mL/min/1.73 m²/year. In multivariable analysis, A3 albuminuria was independently associated with a steeper eGFR decline compared with A1 albuminuria (adjusted β −2.938, 95%CI −3.718 to −2.157, p<0.001), whereas systolic blood pressure, HbA1c, ACEI/ARB use, and dapagliflozin use were not independently associated with eGFR slope. In conclusion, patients with type 2 diabetes mellitus and CKD stages G2–G3a had a relatively high rate of kidney function decline. Severe albuminuria was an important factor associated with faster eGFR decline. Combined monitoring of UACR and serial eGFR may help identify patients at high risk of CKD progression.