Abstract
Background and Aims
Diabetes mellitus (DM) is the leading cause of chronic kidney disease; principally resulting from the increasing prevalence of type 2 DM (T2DM). Patients with T2DM pass through pre-diabetic stages and at the time of diagnosis, up to half of the T2DM patients may have different macro- and micro-vascular complications, including diabetic nephropathy. Hypertension has adverse impacts on diabetic nephropathy. This study was designed to evaluate the risk factors for diabetic nephropathy among newly detected T2DM patients with normal blood pressure.
Method
This case-control study was done at out-patient department of a referral hospital in Dhaka, Bangladesh from January 2018 to June 2019. Newly detected (<3 months), adult (≥18 years), T2DM patients of either sex, who underwent test for urine albumin-to-creatinine ratio (UACR), at least twice (6 weeks apart), within a 6-month period, were included in this study. Patients with hypertension (newly diagnosed or known cases/on antihypertensive medications), known kidney disease, features of glomerulonephritis, systemic diseases including systemic lupus erythematosus and vasculitis, history of recent fever and exercise, urinary tract infection and pregnancy were excluded. Patients with UACR ≥30 mg/g in at least two (of three, if done) samples were cases and those with UACR <30 mg/g were controls.
Results
Total patients were 135, including 27 cases [moderately increased proteinuria (previously, microalbuminuria) (UACR 30 – 299 mg/g) = 25 and severely increased proteinuria (previously, overt proteinuria) (UACR ≥300 mg/g) = 2] and 108 controls. Mean age was 42.9 years and there was female (64.8%) predominance. Thirteen percent patients were smokers, 12% had dyslipidaemia, 51% had family history of DM and 44.9% had family history of diabetic nephropathy. Besides diabetic nephropathy, other chronic complications of DM were diabetic retinopathy (6.7%), diabetic peripheral neuropathy (0.7%) and coronary artery disease (1.5%). Regarding risk factors for diabetic nephropathy, family history of DM [odds ratio (OR) = 2.31, 95% confidence interval (CI) = 0.923 – 5.415, p = 0.003) and diabetic nephropathy (OR = 3.28, 95% CI = 1.523 – 9.297, p = 0.001), smoking (OR = 3.08, 95% CI = 1.066 – 0.934, p = 0.003), dyslipidaemia (OR = 2.11, 95% CI = 0.241 – 3.464, p = 0.004) and coexisting diabetic retinopathy (OR = 6.51, 95% CI = 1.46 – 11.79, p = 0.003) were significant. On multivariate logistic regression, family history of DM (OR = 2.13, 95% CI = 1.412 – 4.216, p = 0.003) and diabetic nephropathy (OR = 3.31, 95% CI = 2.145 – 5.249, p = 0.001), smoking (OR = 3.11, 95% CI = 2.234 – 4.123, p = 0.003), dyslipidaemia (OR = 2.14, 95% CI = 1.363 – 3.324, p = 0.005) and diabetic retinopathy (OR = 6.23, 95% CI = 4.197 – 9.464, p = 0.004) were significant.
Conclusion
Family history of DM and diabetic nephropathy, smoking, dyslipidaemia and concomitant diabetic retinopathy were significant risk factors for diabetic nephropathy among newly diagnosed T2DM patients with normal blood pressure.
Faktor Risiko Kejadian Nefropati Diabetika pada Wanita
