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
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.