The Burden of Unrecognised Chronic Kidney Disease in Patients With Type 2 Diabetes at a County Hospital Clinic in Kenya: Implications to Care and Need for Screening

Abstract

BackgroundChronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that would optimize outcomes including forestalling progression to end-stage kidney disease.This study was conducted in a regional referral public health facility in Central Kenya with a higher prevalence of type 2 diabetes. It was aimed at finding out the burden of chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes from, mainly, the rural area. MethodsThis was a cross-sectional survey conducted at the out-patient diabetes clinic of Nyeri County hospital. A total of 385 participants with type 2 diabetes were enrolled over five (5) months. Each subject gave informed consent to participate wherein clinical evaluation was done, a spot sample of urine obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Main outcomes measureEstimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. ResultsOf the 385 participants included in the study, 252 (65.5%) were females. Thirty nine per cent, 39.0% (95%CI 34.3-44.2) had CKD/KDIGO stages 3, 4 and 5 while 32.7% (95%CI, 27.8-37.4) had Albuminuria.The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age >50years, long duration with diabetes >5years and hypertension. Employment and, paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status. ConclusionTherefore, patients with type 2 diabetes should be screened for CKD using spot-urine albuminuria and

“Evaluation of Anti-Inflammatory Effects of Allopurinol in Diabetic Patients with Chronic Kidney Disease (DM-CKD): A Clinical Study”

“…Approximately 15 years after the beginning of DM, diabetic nephropathy develops in 20% to 30% of patients [3,4]. In 2017, the international diabetes federation estimated that 425 million adults between 20 and 79 have diabetes, corresponding to an 8.8% prevalence of diabetes globally [5].…”