Incidence and Predictors of Chronic Kidney Disease among Diabetes Mellitus Patients: A Retrospective Follow-Up Study at a Tertiary Health-Care Setting of Ethiopia

Diabetic retinopathy incidence, predictors and its association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia: joint model

Background

Diabetes mellitus (DM) is a global public health problem characterized by an elevated blood glucose level. Monitoring blood sugar levels is vital for effective diabetes management and preventing complications. However, the association between longitudinal biomarkers and the incidence of diabetic complications is often overlooked. Therefore, this study aimed to assess the incidence of diabetic retinopathy, predictors, and association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia.

Methods

A multicenter retrospective follow-up study was carried out in referral hospitals in Amhara region, Ethiopia. A random sample of 462 newly diagnosed DM patients was selected. The proportional hazard assumption was checked for the survival sub-model, and for the longitudinal sub-model, the normality assumption was checked. Then the joint modeling with time-dependent lagged parameterizations was fitted. Model assumptions and comparisons were checked. Finally, the hazard ratio with a 95% confidence interval (CI) with a corresponding P-value<0.05 was used to identify predictors.

Results

In this study, Overall, 54 patients developed DR, and the incidence rate was 2.33 per 1000 person-months over the follow-up period, with a 95% CI of [1.78, 3.05]. Rural residence (AHR = 2.21, 95% CI: [1.21, 4.05]), hypertension co-morbidity (AHR = 3.01, 95% CI: [1.85, 6.53]), and longer duration of DM (>5 years) (AHR = 2.28, 95% CI: [1.91, 5.15]) were important predictors for the incidence of DR. In addition, the incidence of DR was substantially correlated with the time-dependent lagged value of FBS change (AHR = 4.20, 95% CI [1.62, 10.85]).

Conclusions

In this study, the incidence of diabetic retinopathy was somewhat high when compared to prior similar studies in Ethiopia. A joint model of longitudinal fasting blood sugar level changes was significantly associated with an increased risk of DR. Besides, being rural residence, hypertension co-morbidity, and a longer duration of DM were significant predictors for the incidence of DR. Therefore, public awareness, an integrated care approach, and prioritizing glycemic control are highly recommended.

Incidence and Predictors of Diabetic Nephropathy among Type 2 Diabetes Mellitus Patients, Southern Ethiopia

Background

Diabetic nephropathy is the most common cause of end-stage renal disease, and it brings high morbidity and mortality. Globally, the predominant rise in type II diabetes prevalence significantly increases the incidence of diabetic nephropathy. Therefore, timely diagnosis and prompt management of diabetic nephropathy and early identification of predictors are essential. Thus, this study aimed to determine the incidence and predictors of diabetic nephropathy among type II diabetes mellitus patients.

Methods

A retrospective follow-up study was conducted among 532 type II diabetes patients who enrolled at Hawassa University Comprehensive Specialized Hospital from January 1, 2012, to December 31, 2021. A simple random sampling technique was used to select the study participants. The extracted data were entered into EpiData version 3.1 and analyzed by Stata version 14. A bivariate and multivariable Cox proportional hazard regression analysis was fitted to identify predictors of diabetic nephropathy. The Cox proportional hazards assumption was checked using the Schoenfeld residual test, and the goodness of fit of the model was checked using the Cox-Snell residual test. An adjusted hazard ratio with a 95% confidence interval and P values were used to identify statistically significant predictors.

Results

The overall incidence rate of diabetic nephropathy was 2.71 cases (95% CI: 2.12, 3.47) per 1,000 person-months of observation. Age (AHR = 1.027; 95% CI = 1.005, 1.049), fasting blood sugar (AHR = 1.010; 95% CI = 1.007, 1.013), and systolic blood pressure (AHR = 1.050; 95% CI = 1.031,1.069) were significant positive predictors of diabetic nephropathy, whereas the duration of diabetes longer than five years (AHR = 0.20; 95% CI = 0.09, 0.44) was a protective predictor for the development of diabetic nephropathy.

Conclusion

The incidence rate of diabetic nephropathy was high. Age, fasting blood sugar, systolic blood pressure, and duration of diabetes were found to be independent predictors of diabetic nephropathy. To overcome this public health problem, prompt and effective strategies should be designed based on identified predictors to prevent the development of diabetic nephropathy.

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.

Association of the dietary inflammation index (DII) with the prevalence of chronic kidney disease in patients with type-2 diabetes mellitus

Chronic kidney disease (CKD) is a major complication of diabetes mellitus (DM). Inflammation is an essential component in the process of CKD progression in patients with DM. Diet is a significant determinant of systemic inflammation levels. However, the association between the dietary inflammatory index (DII) and CKD in individuals with DM remains largely unknown; therefore, the aim of this study was to explore whether the DII is linked to the prevalence of CKD in patients with DM. The research method was as follows: first, data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 were obtained. There were 7,974 participants in our study. These individuals were then classified into three groups according to DII tertiles (T1-T3), with each group consisting of 2,658 participants. Logistic regression analysis was employed to examine whether there was a connection between the DII and CKD. We observed a significant association between the DII and the prevalence of CKD in individuals with DM. After full adjustment for age, sex, ethnicity, smoking, drinking, body mass index (BMI), triglyceride (TG), total cholesterol (TC), metabolic equivalents (METs), energy intake, hypoglycemic medications, hypertension, and cardiovascular disease (CVD), the group with a higher DII had a greater frequency of CKD (T2 group: OR: 1.40; 95% CI: 1.10-1.76; p = 0.006; T3 group: OR: 1.67; 95% CI: 1.29-2.17; p < 0.001). The implementation of an anti-inflammatory diet could serve as an intervention strategy for patients with DM to prevent the onset of CKD.

Time to Diabetic Nephropathy and its Predictors Among Diabetic Patients Treated in Wolaita and Dawuro Zone Hospitals, Ethiopia: A Retrospective Cohort Study

Background

Diabetic kidney disease (DKD) develops in nearly half of patients with type 2 diabetes mellitus (DM) and one-third of those with type 1 DM during their lifetime. The incidence of DKD as a cause of end stage renal disease is increasing each year. So this study aimed to assess the time to develop diabetic nephropathy and predictors among diabetic patients treated in Wolaita zone hospitals.

Methodology

A ten-year retrospective cohort study had conducted among 614 diabetic patients using systematic random sampling in Wolaita and Dawuro zone hospitals. Bivariable and multivariable Cox proportional hazards regression had used to identify the possible associations between variables. Those variables with a p-value of less than 0.25 in bivariable analysis exported to multivariable Cox regression analysis. Finally, variables with p-value less than 0.05 at multivariable Cox regression were considered significantly significant. The Cox-proportional hazard model assumption had checked using the Schoenfeld residual test.

Results

Of the total participants, 93 (15.3%; 95% CI = 12.45-18.14) patients had developed nephropathy in 820,048 people year observation. A mean time to diabetic nephropathy in this study was 189.63 (95% CI, 185.01, 194.25) months. Being illiterate (AHR: 2.21, 95% CI: 1.34-3.66), being hypertensive (AHR: 5.76, 95% CI: 3.39-9.59), and being urban dwellers (AHR: 2.25, 95% CI: 1.34-3.77) increases the hazard of nephropathy.

Conclusion

According to this follow-up study, the overall incidence rate is substantially high over ten year follow-up period. The mean time to develop diabetic nephropathy was sixteen years. Educational status, place of residence, and being hypertensive were the predictors. So stakeholders should work on complication reduction measures and awareness creation of the impact of comorbidities.