Kidney Disease Index as a Predictor of Mortality and Chronic Kidney Disease Progression in Asians with Type 2
Care Continuum
Care Process & Redesign
Singapore Health Biomedical Congress
National Healthcare Group
27 January 2026
This study aimed to evaluate the predictive value of KDI for mortality and CKD progression in a multi-ethnic Asian T2DM. This study demonstrates KDIs superior prognostic capability for mortality and renal outcomes, highlighting its potential for.
Year Submitted: 2025
Published Date: 27 January 2026
Tags: Care Continuum, Preventive Care, Community Health, Care Process ＆ Redesign, Quality Improvement, Clinical Practice Improvement, Preventive Approach
About this Content
Aims
This study aimed to evaluate the predictive value of KDI for mortality and CKD progression in a multi-ethnic Asian T2DM cohort.
Background
Chronic kidney disease (CKD) is a major contributor to morbidity and mortality among patients with Type 2 diabetes mellitus (T2DM), particularly in Asia. Standard prognostic markers estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR) exhibited limitations in predictive accuracy when used independently. The Kidney Disease Index (KDI), a composite metric integrating 1/eGFR and Ln(100 uACR), offers a potential solution, but existing studies on specific applicability of KDI in predicting mortality and CKD progression have not adequately validated in Asian populations with T2D and remains underexplored.
Methods
A prospective cohort of 2,232 adults from Singapores SMART2D study (20112023) was analysed. Baseline eGFR and uACR were used to compute KDI. Mortality outcomes were tracked via national registry data; CKD progression (30% eGFR decline) was assessed longitudinally. Cox regression and C-statistics evaluated predictive performance. Mediation analysis explored the indirect impact of KDI through CKD progression.
Results
Over 11.1 years, 440 deaths (19.7%) and 869 CKD progressions (43.6%) occurred. Each unit increase in (In)KDI was associated with a nearly fivefold increase in all-cause (HR 4.89) and cardiovascular mortality (HR 4.85), and robustly predicted CKD progression (HR 4.75). KDI outperformed conventional markers and demonstrated 25.2% of its mortality effect was mediated via CKD progression.
Conclusion
This study demonstrates KDIs superior prognostic capability for mortality and renal outcomes, highlighting its potential for integration into clinical risk stratification frameworks in Asian populations with T2DM.
Lessons Learnt
KDI increased predictive precision and optimizing prognostic metrics. KDI is combining of eGFR and uACR provides additive and synergistic predictive value for adverse outcomes, and potential to develop more accurate future models for CKD regression and the mortality associated with it.
Additional Information
Bronze for Clinical Research in Young Investigator Award Category (Singapore Health & Biomedical Congress 2025)
Keywords
Clincal Research, Kidney Disease Index, Diabetes Mellitus, CKD progression, Cardiovascular Mortality
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Clinical Research Unit, Admiralty Medical Centre, Khoo Teck Puat Hospital |
Platform(s) | Singapore Health Biomedical Congress |
Healthcare Professional Group(s) | Allied Health |
Applicable Specialty or Discipline | Clinical Research, General Medicine, Nephrology |
Project Lead(s) | Allen Liu, Theedaraj Bun Chuan |
Project Member(s) | Kiat Mun Serena Low |
Connect with this contributor!
THEEDARAJ BUN CHUAN - bun.chuan.theedaraj@nhghealth.com.sg