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 Background Chronic 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. Methods This 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 measure Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results Of 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. Conclusion Therefore, patients with type 2 diabetes should be screened for CKD using spot-urine albuminuria and eGFR, then risk-stratified further for cardiovascular disease and likelihood of progression to ESRD. Reducing proteinuria and optimizing control of the modifiable risk factors, especially unawareness, hypertension and hyperglycaemia, by linkage to and retention in quality care is the imperative of screening for chronic kidney disease which is the challenge in publicly-funded hospitals.

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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.

10.21203/rs.2.11876/v3 ◽

2019 ◽

Author(s):

Frederick C. F. Otieno ◽

Elijah N Ogola ◽

Mercy W Kimando ◽

Ken K Mutai

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

County Hospital ◽

End Stage Kidney Disease ◽

Long Duration ◽

End Stage

Abstract Background: Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and is 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 high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. Methods: A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over five months. Informed consent was obtained and 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 measure: Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results: A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 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. Conclusion: Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

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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

10.21203/rs.2.11876/v4 ◽

2020 ◽

Author(s):

Frederick C. F. Otieno ◽

Elijah N Ogola ◽

Mercy W Kimando ◽

Ken K Mutai

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

County Hospital ◽

End Stage Kidney Disease ◽

Long Duration ◽

End Stage

Abstract Background : Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances their cardiovascular risk and diseases, 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 optimizes 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 high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. Methods : A cross-sectional study was conducted at the out-patient of Nyeri County hospital where 385 patients were enrolled over five months. Informed consent was obtained and clinical evaluation was done. A spot sample of urine was 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 measure: Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results : A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 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. Conclusion : Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

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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.

10.21203/rs.2.11876/v5 ◽

2020 ◽

Author(s):

Frederick C. F. Otieno ◽

Elijah N Ogola ◽

Mercy W Kimando ◽

Ken K Mutai

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

County Hospital ◽

End Stage Kidney Disease ◽

Long Duration ◽

End Stage

Abstract Background: Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and is 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 high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. Methods: A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over five months. Informed consent was obtained and 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. Descriptive statistics for data summary and regression analysis were employed on SPSS v23. Results: A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 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. Conclusion: Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

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The Burden Of Unrecognized Chronic Kidney Disease In Patients With Type 2 Diabetes At A County Hospital Clinic In Kenya: Implications To Care And Need For Screening

10.21203/rs.2.11876/v2 ◽

2019 ◽

Author(s):

Frederick C. F. Otieno ◽

Elijah N Ogola ◽

Mercy W Kimando ◽

Ken K Mutai

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Cardiovascular Events ◽

End Stage Kidney Disease ◽

Long Duration ◽

End Stage

Abstract Background : Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the risk of cardiovascular events and a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care for active management that would optimize outcomes including forestalling progression to end-stage kidney disease. This study was conducted in a regional public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at determining the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. Methods : A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over five months. Informed consent was obtained and 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 measure: Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results : A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 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. Conclusion : Previously unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. They were at high risk of progression to end-stage kidney disease and cardiovascular events. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

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Type 2 diabetes in patients with end‐stage kidney disease: influence on cardiovascular disease‐related mortality risk

The Medical Journal of Australia ◽

10.5694/mja18.00195 ◽

2018 ◽

Vol 209 (10) ◽

pp. 440-446 ◽

Cited By ~ 10

Author(s):

Wai H Lim ◽

David W Johnson ◽

Carmel Hawley ◽

Charmaine Lok ◽

Kevan R Polkinghorne ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Kidney Disease ◽

Mortality Risk ◽

End Stage Kidney Disease ◽

End Stage ◽

Related Mortality

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The Association Between Age of Onset of Type 2 Diabetes with Long-term Risk of End Stage Kidney Disease: A National Registry Study

10.2337/figshare.12273110.v1 ◽

2020 ◽

Author(s):

Jedidiah I Morton ◽

Danny Liew ◽

Stephen P McDonald ◽

Jonathan E Shaw ◽

Dianna J Magliano

Keyword(s):

Type 2 Diabetes ◽

Kidney Disease ◽

Cumulative Incidence ◽

Age Of Onset ◽

End Stage Kidney Disease ◽

Onset Of Diabetes ◽

End Stage ◽

Effect Of Age

Objective: The long-term risk of end-stage kidney disease (ESKD) in type 2 diabetes is poorly described, as is the effect that younger age of diabetes onset has on this risk. Therefore, we aimed to estimate the effect of age of onset on the cumulative incidence of ESKD from onset of type 2 diabetes. Research Design and Methods: This study included 1,113,201 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2002 until 2013. The NDSS was linked to the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Death Index. Results: Between 2002 and 2013, there were 7,592 incident cases of ESKD during 7,839,075 person-years of follow up. In the first 10-15 years following onset of diabetes, the incidence of ESKD was highest in those with an older age of onset of diabetes, whereas over longer durations of diabetes the incidence of ESKD became higher in those with younger-onset diabetes. After 40 years of diabetes, the cumulative incidence of ESKD was 11.8% and 9.3% in those diagnosed with diabetes aged 10-29 and 30-39 years, respectively. When death from ESKD without renal replacement therapy was included, incidence of ESKD remained higher in older onset diabetes for the initial 20 years, with no clear effect of age thereafter. Conclusions: The long-term risk of ESKD in type 2 diabetes is high, which disproportionately affects those with younger-onset of diabetes as they are more likely to survive to longer diabetes durations.

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Differences in Risk Factors for Diabetic Retinopathy in Type 1 and Type 2 Diabetes Mellitus Patients in North-East Poland

Medicina ◽

10.3390/medicina56040177 ◽

2020 ◽

Vol 56 (4) ◽

pp. 177

Author(s):

Wojciech Matuszewski ◽

Magdalena M. Stefanowicz-Rutkowska ◽

Magdalena Szychlińska ◽

Elżbieta Bandurska-Stankiewicz

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Kidney Disease ◽

Study Group

Background and Objective: Nowadays, diabetes is one of the main causes of blindness in the world. Identification and differentiation of risk factors for diabetic retinopathy depending on the type of diabetes gives us the opportunity to fight and prevent this complication. Aim of the research: To assess differences in the risk factors for diabetic retinopathy in type 1 and type 2 diabetes mellitus patients in Warmia and Mazury Region, Poland. Materials and Methods: Risk factors for diabetic retinopathy (DR) were assessed on the basis of an original questionnaire, which included: personal data, clinical history of diabetes and eye disease. Elements of clinical examination: blood pressure, BMI, waist circumference. Indicators of diabetes metabolic control: mean glycemia, glycated hemoglobin (HbA1c), total cholesterol and triglycerides, creatinine, glomerular filtration rate (GFR), albumin–creatinine ratio in urine. Results: The study group included 315 (26%) patients with DM1 and 894 (74%) patients with DM2. Risk factors were estimated on the basis of logistic regression and verified with Student’s t-test. Statistically significant dependencies were found in both groups between the occurrence of diabetic retinopathy and diabetes duration, HbA1c, triglyceride concentrations, indicators of kidney function and cigarette smoking status. In the DM2 group, the development of DR was significantly influenced by the implemented models of diabetic treatment. Conclusions: In the whole study group, the risk of DR was associated with the duration of diabetes, HbA1c, triglyceride concentrations and smoking. In DM1 patients, the risk of DR was associated with diabetic kidney disease in the G1A1/A2 stage of chronic kidney disease, and in DM2 patients with the G2 stage of chronic kidney disease. An important risk factor for DR in DM2 patients was associated with late introduction of insulin therapy.

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Retinopathy progression and the risk of end-stage kidney disease: results from a longitudinal Japanese cohort of 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000726 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000726 ◽

Cited By ~ 6

Author(s):

Masayuki Yamanouchi ◽

Mikiro Mori ◽

Junichi Hoshino ◽

Keiichi Kinowaki ◽

Takeshi Fujii ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Kidney Disease ◽

Diabetic Kidney Disease ◽

End Stage Kidney Disease ◽

Diabetic Kidney ◽

Clinical Model ◽

Renal Lesions ◽

End Stage

ObjectiveThe predictive value of diabetic retinopathy on end-stage kidney disease (ESKD) has not been fully addressed in patients with type 2 diabetes and diabetic kidney disease.Research design and methodsWe studied 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease who were screened for diabetic retinopathy during the 1 month of kidney biopsy. We examined the association between retinopathy progression and renal lesions. We used Cox regression analyses to explore the risk of ESKD adjusting for known risk demographic and clinical variables. We assessed the incremental prognostic value of ESKD by adding diabetic retinopathy to the clinical variables.ResultsThe diabetic retinopathy progression positively correlated with all scores of renal lesions, especially with the glomerular-based classification (r=0.41), scores of interstitial fibrosis (r=0.41) and diffuse lesion (r=0.48). During a median follow-up of 5.7 years, 114 patients developed ESKD. Adjusting for known risk factors of ESKD, the HR for ESKD (patients with no apparent retinopathy as a reference) were 1.96 (95% CI 0.62 to 6.17) for patients with mild non-proliferative diabetic retinopathy (NPDR), 3.10 (95% CI 1.45 to 6.65) for patients with moderate NPDR, 3.03 (95% CI 1.44 to 6.37) for patients with severe NPDR, and 3.43 (95% CI 1.68 to 7.03) for patients with proliferative diabetic retinopathy, respectively. Addition of the retinopathy grading to the clinical model alone improved the prognostic value (the global χ2 statistic increased from 155.2 to 164.5; p<0.001), which is an improvement equivalent to the addition of the renal lesion grading to the clinical model.ConclusionsRetinopathy progression appeared to be associated with renal lesions and the development of ESKD. Our findings suggest that diabetic retinopathy and kidney disease share the same magnitude of disease progression, and therefore diabetic retinopathy may be useful for prognosticating the clinical course for diabetic kidney disease.

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