Chronic Kidney Disease among Diabetes Patients in Ethiopia: A Systematic Review and Meta-Analysis

Abstract

Background. Though different primary studies have reported the burden of chronic kidney disease among diabetes patients, their results have demonstrated substantial variation regarding its prevalence in Ethiopia. Therefore, this study aimed to estimate the pooled prevalence of chronic kidney disease and its associated factors among diabetes patients in Ethiopia. Method. PubMed, African Journals Online, Google Scholar, Scopus, and Wiley Online Library were searched to identify relevant studies. The I2 statistic was used to check heterogeneity across the included studies. A random-effects model was applied to estimate the pooled effect size across studies. A funnel plot and Egger’s regression test were used to determine the presence of publication bias. All statistical analyses were performed using STATA™ version 14 software. Result. In this meta-analysis, a total of 12 studies with 4,075 study participants were included. The estimated prevalence of CKD among diabetes patients was found to be 35.52% (95% CI: 25.9–45.45, I2 = 96.3%) for CKD stages 1 to 5 and 14.5% (95% CI: 10.5–18.49, I2 = 91.1%) for CKD stages 3 to 5. Age greater than 60 years (OR = 2.99; 95% CI: 1.56–5.73), female sex (OR = 1.68; 95% CI: 1.04–2.69), duration of diabetes >10 years (OR = 2.76; 95% CI: 1.38–5.51), body mass index >30 kg/m2 (OR = 2.06; 95% CI: 1.41–3.00), type 2 diabetes (OR = 2.54; 95% CI: 1.73–3.73), poor glycemic control (OR = 2.01; 95% CI: 1.34–3.02), fasting blood glucose >150 mg/dl (OR = 2.58; 95% CI: 1.79–3.72), high density lipoprotein >40 mg/dl (OR = 0.48; 95% CI: 0.30–0.85–25), systolic blood pressure>140 mmHg (OR = 3.26; 95% CI: 2.24–4.74), and diabetic retinopathy (OR = 4.54; CI: 1.08–25) were significantly associated with CKD. Conclusion. This study revealed that the prevalence of chronic kidney disease remains high among diabetes patients in Ethiopia. This study found that a long duration of diabetes, age>60 years, diabetic retinopathy, female sex, family history of kidney disease, poor glycemic control, systolic blood pressure, overweight, and high level of high-density lipoprotein were associated with chronic kidney disease among diabetic patients. Therefore, situation-based interventions and context-specific preventive strategies should be developed to reduce the prevalence and risk factors of chronic kidney disease among diabetes patients.

Diabetes comorbidities in low- and middle-income countries: An umbrella review

“…After quality assessment, we excluded nine reviews of critically low confidence mainly due to insufficient primary study details and lack of risk of bias or quality appraisal (Table S2 in the Online Supplementary Document ). We therefore included a total of 14 reviews, which focused on diabetes in relation to CVD (two reviews) [ 24 , 25 ], CKD (two reviews) [ 26 , 27 ], depression (five reviews) [ 28 - 32 ], and TB (five reviews) [ 33 - 37 ] ( Table 1 ). We did not identify any eligible reviews on the association between diabetes and pneumonia.…”

“…This number of participants does not include those from the 41 cross-sectional studies included in the included review by Uphoff et al [ 29 ] which did not provide this information. Of the 14 included reviews, only eight [ 25 , 27 - 31 , 33 , 34 ] focused solely on LMICs. The other six reviews included a mix of primary studies from HICs and LMICs, with the majority often being from HICs.…”

“…Seventy-eight percent of participants (3 060 517) came from a single Russian cross-sectional study [ 39 ] and many studies were from Iran and India due to country-specific reviews including 44 and 43 cross-sectional studies, respectively [ 30 , 31 ]. One review was assessed to be of high confidence [ 37 ], ten of moderate confidence [ 24 , 26 , 29 - 36 ] and three of low confidence [ 25 , 27 , 28 ] ( Table 1 and more detailed appraisal in Table S2 in the Online Supplementary Document ). Main findings for each systematic review and meta-analysis are summarised in Table 3 .…”

“…We identified two reviews [ 26 , 27 ] on CKD occurrence amongst people with diabetes, one of which only included two LMIC studies out of 71 included studies [ 26 ], while the other included 12 studies from Ethiopia [ 27 ]. The studies from the former were both cohort studies, including a combined total of 1114 participants with diabetes [ 26 ].…”

“…We performed a secondary meta-analysis on the review by Shiferaw et al, which included two cohort, one case-control, and nine cross-sectional studies [ 27 ]. The authors provided prevalence estimates separately for CKD stages 1-5 and 3-5, so we did the same for our secondary meta-analysis.…”