Project Spotlight – Understanding why kidney disease affects some groups more than others

Kidney disease does not affect everyone in Singapore equally. Some communities face a higher risk than others — but why these differences exist, and what can be done about them, is still not fully understood. 

For A/Prof Yeo See Cheng, Senior Consultant from the Department of Renal Medicine at Tan Tock Seng Hospital, answering these questions could help pave the way for better prevention, earlier detection and more targeted care. 

Through his research, Unravelling the Determinants of Kidney Health in a Multi-Ethnic Asian Population, A/Prof Yeo and his team are examining how genes, chronic conditions, lifestyle and environmental factors contribute to differences in kidney disease risk across Singapore’s population.

We caught up with A/Prof Yeo to find out what the research is uncovering, how TRUST is enabling the team to investigate these questions, and what the findings could ultimately mean for kidney health in Singapore. 

The research team also includes Xiaoyan Wang, Geraldine Boh, Pritesh R Jain, Theresia H Mina, Marie Loh Chiew Shia and John C Chambers, from the Department of Renal Medicine, Tan Tock Seng Hospital, NHG Health, and the Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.

1. What first prompted your team to look more closely at why kidney disease affects different groups in Singapore differently?  

Kidney disease does not affect all communities in Singapore equally. The Singapore Renal Registry (opens in new tab) shows that the rate of new kidney failure is almost three times higher in Malays and about 1.3 times higher in Indians than in Chinese, a gap The Straits Times (opens in new tab) has also reported. Males and females, young and old are also affected differently. Yet most of what we know about the causes of kidney disease comes from Western populations, so we could not fully explain these differences. Advancing kidney health means connecting population health and precision medicine: using insights from the whole population to understand how risk differs across communities and individuals, so that prevention and care can be tailored to those who need it most. 

2. Your study brings together clinical, lifestyle, socioeconomic, and genetic factors. Why was it important to examine these different factors together?  

Kidney disease rarely has a single cause: clinical conditions, lifestyle, social circumstances, and genes interact, and they often cluster differently across groups. Studying them together showed us how much of each group's excess risk each factor explains, and how much remains unexplained. Importantly, many of these factors, such as diabetes, blood pressure, weight, diet, physical activity and smoking, can be changed, so individuals and families can be empowered to lower their risk of developing kidney disease or of it getting worse. 

3. What have been the key findings so far on how kidney health and its risk factors differ across Singapore’s multi-ethnic population?  

Current registry data counts people only once they reach kidney failure. Our study wanted to dive deeper, and looked at people before they developed chronic kidney disease (CKD). We found in its early stages that kidney function was already lower and CKD more common in Malays and Indians than in Chinese. Diabetes, obesity, high blood pressure, and high cholesterol were not only more common in these groups but often more severe, and this earlier view helps us move from reacting once kidneys fail to helping people protect their kidney health. That shift shapes how we design screening strategies, treatment targets, and population health interventions. 

4. Was there anything in the findings that particularly surprised you or challenged what you previously understood about kidney disease risk?  

One finding that stood out was that diabetes seemed to harm the kidneys more in Malays than in other groups, showing that the same risk factor can affect different people differently. This means that for certain groups, better control of diabetes and high blood pressure could do a great deal to protect kidney health. We also found that Malays had lower kidney function even without the usual risk factors, and understanding what drives this remaining risk could reveal new causes, fresh insights and, in time, new treatments for kidney disease. 

5. Some differences in kidney health appear to remain even after accounting for common risk factors such as diabetes, high blood pressure, and obesity. What might be driving these remaining differences, and what questions does this raise for further research?  

Possible explanations include genetic variants that current risk scores miss, since those scores were built largely from non-Asian populations. Others are early-life factors that shape how the kidneys develop, dietary patterns, and differences in access to and uptake of preventive care. This raises questions we are keen to pursue, such as which genes matter in Asian populations, when in life the risk begins, whether gaps in care delivery play a part, and whether specific interventions may be especially helpful in Asian populations. 

6. What could these findings eventually mean for how we identify people at higher risk and approach the prevention or early detection of kidney disease in Singapore?  

These findings support moving from a one-size-fits-all approach to one that reflects each group's level of risk. That could mean earlier or more frequent kidney checks for higher-risk groups, and closer control of diabetes and blood pressure where it protects the kidneys most. Because many of these risk factors can be changed, they also point to population health and community programmes that help individuals and families protect their kidney health long before kidney failure, with tailored treatment targets to follow once they have been tested. 

7. What did having access to linked data through TRUST allow your team to investigate that would have been difficult to study otherwise?  

TRUST let us bring together detailed health measurements, lifestyle and socioeconomic information, genetic data, and routine healthcare records in one secure environment – data thatwould otherwise sit in separate silos. That scale and linkage gave us the power to test whether risk factors act differently across ethnic groups and to follow who goes on to develop kidney disease or whose kidney function declines over time. 

8. Looking ahead, what are the next steps for this research, and what would you ultimately like to see it contribute to kidney health in Singapore? 

Our next step is to follow people over time through their linked health records, to understand who develops CKD and whose kidney disease worsens. We will combine clinical measurements, medication records, hospital admissions and other outcomes that matter most to patients, and link these to insights from our laboratory research. This bedside-to-bench-and-back approach should show who is most at risk and which interventions best protect their kidneys. Ultimately, we would like this work to help Singapore move from treating kidney failure to protecting kidney health for the entire population. 

Interested to learn more? Watch this video (opens in new tab) for more insights into kidney health in Singapore.