Prevalence and awareness of chronic kidney disease among adult diabetic outpatients in Northeast Ethiopia

Prevalence of chronic kidney disease and its associated factors among diabetes mellitus patients in Dessie Referral Hospital, South Wollo, Ethiopia

Diabetes mellitus shares a large proportion of kidney failure. Despite many patients suffering from diabetes mellitus and its complications in Dessie City, no study was conducted in the study area that shows the prevalence and associated factors of chronic kidney disease among diabetes mellitus patients. Therefore, this study aims to assess the prevalence of chronic kidney disease and its associated factors among adult diabetes mellitus patients attending Dessie Referral Hospital, South Wollo, Northeast Ethiopia. An institutional-based cross-sectional study was conducted at Dessie Referral Hospital among 267 randomly selected adult diabetic patients. Data were collected using questionnaires administered by interviewers. The glomerular filtration rate was estimated from serum creatinine levels. Data were entered into Epi-data version 4.6 and analyzed using SPSS version 26 software. Multi-variable logistic regression was used to determine the strength of association for the associated factors of chronic kidney disease. Variables with a p value < 0.05 were used to ascertain statistically significant associations. A total of 267 diabetic patients participated in this study. About 104 (39%) of the respondents were female and from the total, 133 (48.1%) were hypertensive. The overall prevalence of chronic kidney disease in this study was 31.5% (95% CI 25.3-37.1%). Being older (p-value = 0.003) and having hypertension (p-value = 0.043) were significant factors for chronic kidney disease among diabetes mellitus patients. This study found a high prevalence (31.5%) of chronic kidney disease among diabetic patients. Older age, having hypertension, and elevated serum creatinine were statistically significant associated factors of chronic kidney disease among patients with diabetes mellitus. Thus, clinicians should be aware of the high prevalence of chronic kidney disease in Dessie City. Moreover, emphasis should be given for old age and hypertension as contributing factors to the high prevalence in diabetic patients.

Effectiveness of a Disease Management Program (DMP) in controlling the progression of Chronic Kidney Disease among hypertensives and diabetics

Background

The occurrence rate of stage 5 chronic kidney disease (CKD) will be 151 per million population in India in the coming years. Comorbidities like diabetes mellitus and hypertension are the usual triggers of CKD. Hence this study aimed to control the progression of CKD and to note the effectiveness of a structured education program that would help in the prevention of complications related to diabetes and hypertension.

Methods

This quasi-experimental study was conducted among 88 participants who had hypertension, diabetes mellitus, or both for five or more years. The study objective was to find the effect of a Disease Management Program on delaying progression of CKD in patients with hypertension or diabetes mellitus.The baseline data were obtained from demographic proforma, and the clinical data collected were the blood pressure, serum creatinine, and random blood sugar (RBS) of the participants. The management of hypertension and diabetes mellitus was taught to them. In the fourth and the eighth month, blood pressure and blood sugar were reassessed. At one-year blood pressure, blood sugar, and serum creatinine were tested. Baseline and one-year follow-up blood pressure, blood sugar, and estimated Glomerular Filtration Rate were compared. Descriptive statistics and "Wilcoxon signed-rank test" were used to analyze the data.

Results

In one year, the mean systolic blood pressure reduced by six mm of Hg and mean blood sugar by 24 mg/dl. The prevalence of CKD stage three and above (< 60 ml/min/m2) was nine (10.22%). The median decline in eGFR was 5 ml/min/m2 (Z= 5.925, P< 0.001).

Conclusion

The Disease Management Program led to improvements in blood pressure and diabetes control and median progression of CKD was estimated at five ml/min/m2/year.

Determinants of diabetic nephropathy among diabetic patients in Ethiopia: Systematic review and meta-analysis

INTRODUCTION

Diabetic nephropathy (DN) is a long-term kidney disease among diabetic patients. It is the leading cause of end-stage renal failure. In Ethiopia, DN affects the majority of diabetic populations, but there were inconsistent findings about the determinant factors across the studies.

METHODS

We have accessed studies using PubMed, Embase, EBSCO, Web of Science, OVID, and search engines including Google and Google Scholar published up to June 2023. The study populations were diabetic patients with nephropathy. The quality of each included article was assessed using the Newcastle-Ottawa quality assessment scale. The odds ratios of risk factors were pooled using a random-effect meta-analysis model. Heterogeneity was assessed using the Cochrane Q statistics and I-Square (I2). The publication bias was detected using the funnel plot and/or Egger's test (p< 0.05). Trim and fill analysis was carried out to treat the publication bias. The protocol has been registered with the reference number CRD42023434547.

RESULTS

A total of sixteen articles were used for this reviewed study. Of which, eleven articles were used for advanced age, ten articles for duration of diabetic illness, ten articles for poor glycemic control, and eleven articles for having co-morbid hypertension. Diabetic patients with advanced age (AOR = 1.11, 95% CI: 1.03-120, I2 = 0.0%, p = 0.488), longer duration of diabetic illness (AOR = 1.23, 95% CI = 1.05-1.45, I2 = 0.0%, p = 0.567), poor glycemic control (AOR = 2.57, 95% CI: 1.07-6.14; I2 = 0.0%, p = 0.996), and having co-morbid hypertension (AOR = 4.03, 95% CI: 2.00-8.12, I2 = 0.0%, p = 0.964) were found to be factors associated with DN.

CONCLUSIONS

The findings of the study revealed that diabetic patients with advanced age, longer duration of diabetic illness, poor glycemic control status, and co-morbid hypertension were the determinant factors of DN. Therefore, treatment of co-morbid hypertension and high blood glucose and regular screening of renal function should be implemented to detect, treat, and reduce the progression of DN. Furthermore, healthcare workers should give due attention to diabetes with advanced age and a longer duration of diabetes illness to prevent the occurrence of DN.

Incidence and predictors of chronic kidney disease among patients with diabetes treated at governmental hospitals of Harari Region, eastern Ethiopia, 2022

Background

Chronic kidney disease (CKD) is the leading cause of morbidity and mortality in diabetic patients. However, limited evidence is available about its incidence and predictors in Ethiopia, specifically in the Harari region.

Methods

A retrospective follow-up study was conducted among 520 diabetes patients who followed their treatment at governmental hospitals in the Harari region between 1 September 2012, and 30 May 2022. The risk of developing CKD was calculated with a 95% CI, and the risk was stratified by type of diabetes mellitus. Predictors of CKD were determined using the Gompertz regression model with the baseline Cox model.

Results

Data from 494 patients were included in the final analysis with 26 (5%) excluded. A total of 51 patients (10.32%) developed CKD over the 10-year follow-up period with an incidence rate of 2.16 cases (95% CI 1.64-2.84) per 100 person-years of observation. The risk of CKD was increased by three times (AHR: 3.09, 45 95% CI: 1.56, 6.14) among patients older than 60 years and by more than three times (AHR: 3.53, 95% CI: 1.43, 8.71) among patients with diabetes mellitus for longer than 5 years of stay with the diabetes mellitus. Moreover, the risk of CKD was increased four-fold among patients with high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL (AHR: 3.84, 95% CI, 1.80-8.18) and those with positive baseline proteinuria (AHR: 3.77, 95% CI: 1.43-8.71).

Conclusion

We found that one in ten diabetic patients had developed CKD within 10 years of the diabetes mellitus diagnosis. Advanced age, longer duration of diabetes, lower baseline HDL-C level, and proteinuria had increased the hazards of developing CKD. We recommend a more focused follow-up of older adult patients with advanced disease status at baseline for optimal control of diabetes mellitus that prevents its furthering to CKD.

Measuring the Awareness of Chronic Kidney Disease (CKD) with Environmental Evaluation among Adult Diabetic Patients in Hail Region, Saudi Arabia

Introduction

Chronic kidney disease (CKD) is one of the main chronic complications of T2DM that happens among T2DM patients who have uncontrolled glucose. Because CKD is considered a silent disease, the diagnosis is usually made at late stages when there will be few chances to prevent the adverse outcome.

Aim

The goal of this study was to assess adult diabetic patients' awareness of developing chronic kidney disease at the community level in Hail region, Saudi Arabia, in 2022. Patients and Methods. This is a cross-sectional study conducted among diabetic patients in the Hail region, Saudi Arabia. A self-administered questionnaire translated into Arabic was distributed among patients with DM. The questionnaire covers social and demographic variables (such as age, gender, relationship status, and so on) as well as a 7-item questionnaire to assess the DM population's knowledge of CKD.

Results

400 DM patients responded to our survey (51% females vs 49% males). Patients who were diagnosed with type 2 diabetes were 23.8% and 40.5% had a diabetes duration of 5–15 years. Nearly half (46.8%) were considered as a poor level of awareness, 29.3% had a moderate, and 24% had a good awareness level. Factors associated with an increased level of awareness were being a bachelor's degree, being unmarried, being a student, and having a doctor as a source of CKD information.

Conclusion

There was a deficiency in the level of awareness among the diabetic patients in our region. Patients who were single with better education and who were well informed by the doctors about CKD information tend to be more aware of CKD as compared to other DM patients. Further research is warranted in order to establish the awareness level of DM patients regarding CKD and its complications.

Prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia: A systematic review and meta-analysis

Objective:

The main aim of this systematic review and meta-analysis is to provide summarized evidence on the prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia.

Method:

Databases of MEDLINE/PubMed, Embase, Google Scholar, CINAHL, Cochrane library, and ScienceDirect were searched. In addition, gray literatures were searched manually from university repositories. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to select potential studies. Microsoft Excel 2013 sheet template was used to extract data. The quality of included studies was assessed by utilizing the Newcastle-Ottawa Scale. STATA software version 14.0 is used to compute the estimated pooled prevalence and associated factors of chronic kidney disease.

Result:

Twelve articles that fulfilled the inclusion criteria were included. The pooled estimate of chronic kidney disease among patients with chronic illnesses in Ethiopia is 21.71% (95% confidence interval: 17.67, 25.74). The highest prevalence of chronic kidney disease among patients with chronic illnesses is from Oromia (32.55% (confidence interval: 19.91, 45.19)). Glomerular filtration rate showed a comparable pooled prevalence from Cockroft-Gault and MDRD methods; 22.38% (confidence interval: 15.83, 28.92), 22.18 (confidence interval: 18.01, 26.34), respectively. Hypertensives become more likely to have chronic kidney disease compared with normotensive patients, (odds ratio = 3.01, 95% confidence interval: 1.33, 6.81).

Conclusion:

Prevalence of chronic kidney disease among chronic illness patients was significantly high. Hypertension is significantly associated with chronic kidney disease. Hence, we recommend that continuous screening of possible risk factors and proper follow-up and management strategies should be designed.

Serum chromogranin A correlated with albuminuria in diabetic patients and is associated with early diabetic nephropathy

BACKGROUND

The kidney is the main site for the removal of chromogranin A (CgA). Previous studies have found that patients with renal impairment displayed elevated concentrations of CgA in plasma and that CgA concentrations reflect a deterioration of renal function. In this study, we aimed to estimate serum CgA levels and to evaluate the role of serum CgA in the early diagnosis of diabetic nephropathy (DN).

METHODS

A total of 219 patients with type 2 diabetes mellitus (T2DM) were included in this cross-sectional study. These patients were classified into normoalbuminuria (n = 121), microalbuminuria (n = 73), or macroalbuminuria (n = 25) groups based on their urine albumin to creatinine ratios (UACRs). The degree of DN is reflected by UACR. A control group consisted of 45 healthy subjects. The serum CgA levels were measured by ELISA, and other key parameters were assayed.

RESULTS

Serum CgA levels were higher in patients with T2DM than in control subjects, and a statistically significant difference among the studied subgroups regarding CgA was found (P < 0.05). The levels of serum CgA increased gradually with the degree of DN (P < 0.001). Serum CgA levels showed a moderate-intensity positive correlation with UACRs (P < 0.001). A cutoff level of 3.46 ng/ml CgA showed 69.86% sensitivity and 66.12% specificity to detect DN in the early stage.

CONCLUSION

The levels of serum CgA increased gradually with the degree of DN and can be used as a biomarker in the early detection of DN.

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

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.