Disparities in ethnicity and metabolic disease burden in referrals to nephrology
Introduction: The profile of patients referred from primary to tertiary nephrology care is unclear. Ethnic Malay patients have the highest incidence and prevalence of kidney failure in Singapore. We hypothesised that there is a Malay predominance among patients referred to nephrology due to a higher...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer – Medknow Publications
2025-06-01
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| Series: | Singapore Medical Journal |
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| Online Access: | https://journals.lww.com/10.4103/singaporemedj.SMJ-2022-193 |
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| author | Yan Ting Chua Cheang Han Leo Horng Ruey Chua Weng Kin Wong Gek Cher Chan Anantharaman Vathsala Ye Lu Mavis Gan Boon Wee Teo |
| author_facet | Yan Ting Chua Cheang Han Leo Horng Ruey Chua Weng Kin Wong Gek Cher Chan Anantharaman Vathsala Ye Lu Mavis Gan Boon Wee Teo |
| author_sort | Yan Ting Chua |
| collection | DOAJ |
| description | Introduction:
The profile of patients referred from primary to tertiary nephrology care is unclear. Ethnic Malay patients have the highest incidence and prevalence of kidney failure in Singapore. We hypothesised that there is a Malay predominance among patients referred to nephrology due to a higher burden of metabolic disease in this ethnic group.
Methods:
This is a retrospective observational cohort study. From 2014 to 2018, a coordinator and physician triaged patients referred from primary care, and determined co-management and assignment to nephrology clinics. Key disease parameters were collated on triage and analysed.
Results:
A total of 6,017 patients were studied. The mean age of patients was 64 ± 16 years. They comprised 57% men; 67% were Chinese and 22% were Malay. The proportion of Malay patients is higher than the proportion of Malays in the general population (13.4%) and they were more likely than other ethnicities to have ≥3 comorbidities, including diabetes mellitus, hypertension, hyperlipidaemia, coronary artery disease and stroke (70% vs. 57%, P < 0.001). Malay and Indian patients had poorer control of diabetes mellitus compared to other ethnicities (glycated haemoglobin 7.8% vs. 7.4%, P < 0.001). Higher proportion of Malay patients compared to other ethnicities had worse kidney function with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 on presentation (28% vs. 24%, P = 0.003). More ethnic Malay, Indian and younger patients missed appointments.
Conclusion:
A disproportionately large number of Malay patients are referred for kidney disease. These patients have higher metabolic disease burden, tend to miss appointments and are referred at lower eGFR. Reasons underpinning these associations should be identified to facilitate efforts for targeting this at-risk population, ensuring kidney health for all. |
| format | Article |
| id | doaj-art-a6cd40e7f48b46a19df14e91e76ebaba |
| institution | Matheson Library |
| issn | 0037-5675 2737-5935 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wolters Kluwer – Medknow Publications |
| record_format | Article |
| series | Singapore Medical Journal |
| spelling | doaj-art-a6cd40e7f48b46a19df14e91e76ebaba2025-07-06T09:37:31ZengWolters Kluwer – Medknow PublicationsSingapore Medical Journal0037-56752737-59352025-06-0166630130610.4103/singaporemedj.SMJ-2022-193Disparities in ethnicity and metabolic disease burden in referrals to nephrologyYan Ting ChuaCheang Han LeoHorng Ruey ChuaWeng Kin WongGek Cher ChanAnantharaman VathsalaYe Lu Mavis GanBoon Wee TeoIntroduction: The profile of patients referred from primary to tertiary nephrology care is unclear. Ethnic Malay patients have the highest incidence and prevalence of kidney failure in Singapore. We hypothesised that there is a Malay predominance among patients referred to nephrology due to a higher burden of metabolic disease in this ethnic group. Methods: This is a retrospective observational cohort study. From 2014 to 2018, a coordinator and physician triaged patients referred from primary care, and determined co-management and assignment to nephrology clinics. Key disease parameters were collated on triage and analysed. Results: A total of 6,017 patients were studied. The mean age of patients was 64 ± 16 years. They comprised 57% men; 67% were Chinese and 22% were Malay. The proportion of Malay patients is higher than the proportion of Malays in the general population (13.4%) and they were more likely than other ethnicities to have ≥3 comorbidities, including diabetes mellitus, hypertension, hyperlipidaemia, coronary artery disease and stroke (70% vs. 57%, P < 0.001). Malay and Indian patients had poorer control of diabetes mellitus compared to other ethnicities (glycated haemoglobin 7.8% vs. 7.4%, P < 0.001). Higher proportion of Malay patients compared to other ethnicities had worse kidney function with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 on presentation (28% vs. 24%, P = 0.003). More ethnic Malay, Indian and younger patients missed appointments. Conclusion: A disproportionately large number of Malay patients are referred for kidney disease. These patients have higher metabolic disease burden, tend to miss appointments and are referred at lower eGFR. Reasons underpinning these associations should be identified to facilitate efforts for targeting this at-risk population, ensuring kidney health for all.https://journals.lww.com/10.4103/singaporemedj.SMJ-2022-193ethnicitymetabolic syndromeprimary health carereferral and consultationrenal insufficiencychronic |
| spellingShingle | Yan Ting Chua Cheang Han Leo Horng Ruey Chua Weng Kin Wong Gek Cher Chan Anantharaman Vathsala Ye Lu Mavis Gan Boon Wee Teo Disparities in ethnicity and metabolic disease burden in referrals to nephrology Singapore Medical Journal ethnicity metabolic syndrome primary health care referral and consultation renal insufficiency chronic |
| title | Disparities in ethnicity and metabolic disease burden in referrals to nephrology |
| title_full | Disparities in ethnicity and metabolic disease burden in referrals to nephrology |
| title_fullStr | Disparities in ethnicity and metabolic disease burden in referrals to nephrology |
| title_full_unstemmed | Disparities in ethnicity and metabolic disease burden in referrals to nephrology |
| title_short | Disparities in ethnicity and metabolic disease burden in referrals to nephrology |
| title_sort | disparities in ethnicity and metabolic disease burden in referrals to nephrology |
| topic | ethnicity metabolic syndrome primary health care referral and consultation renal insufficiency chronic |
| url | https://journals.lww.com/10.4103/singaporemedj.SMJ-2022-193 |
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