DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20182453

Chronic kidney disease-prevalence and determinants among type 2 diabetes mellitus patients attending a primary care setting in central Kerala

Sajith Kumar Soman, Binu Areekal, Rosin George Varghese, Susan John, Radhika S. Gopan, Quincy Mariam Jacob, Amruthaa Raman Nair

Abstract


Background: Diabetes mellitus (DM) is one of the most common metabolic diseases characterized by increased blood glucose levels either due to insufficiency/absence of insulin or due to decrease in the insulin sensitivity. The prevalence of chronic kidney disease (CKD) in people with type 2 diabetes is three times higher than in non-diabetic population and majority of people developing end-stage renal diseases (ESRD) have Type 2 DM. The objectives of the study were to find out the prevalence of CKD, mean GFR and associated factors of CKD, in diabetics coming to a primary health care setting in Central Kerala.

Methods: A cross-sectional study among all patients attending the NCD clinic of Health Centre, Ettumanoor with confirmed diagnosis of type 2 diabetes mellitus was done between February 2017 and April 2017.

Results: The prevalence of CKD among the study population was 45.3%. The proportion of CKD was 34.9% among those with nil urinary protein, 57.1% among those with 1+ urinary protein, 88.9% for those with 2+ and 87.5% among those with 3+ urinary protein. Among those with CKD mean duration of diabetes was 121.92 months against 92.72 months among those without CKD. There was statistically significant difference between RBS values of those with CKD and without CKD (238.49 mg% versus 199.41 mg%). The proportion of CKD was found increase with duration of diabetes 5 years (31.2%), 5-10 years (47.8%), 10-15 years (52.6%) and >15 years (55%).

Conclusions: The study showed high prevalence of CKD among diabetics. The duration of diabetes, urinary protein levels and RBS value were found to have strong association with CKD in diabetics.


Keywords


Chronic kidney disease, Diabetes, Kerala

Full Text:

PDF

References


Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harrison's Principles of Internal Medicine. In: Alvin CP, editor. Diabetes mellitus. 16th ed. New York: McGraw Hill; 2008: 2152-2153.

IDF-Diabetic fact sheet –India. Available at: https://www.idf.org/our-network/regions-members/south-east-asia/members/94-india.html

United States Renal Data System. International Comparisons. In United States Renal Data System. 2014 USRDS annual data report: Epidemiology of kidney disease in the United States. Bethesda (MD): National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2014: 188–210.

Tan J, Zwi LJ, Collins JF, Marshall MR, Cundy T. Presentation, pathology and prognosis of renal disease in type 2 diabetes. BMJ Open Diabetes Research Care. 2017;5:e000412.

Arora P. Chronic Kidney Disease Clinical Presentation. MEDSCAPE. Available at: https://emedicine.medscape.com/article/238798-clinical. Accessed on 3 March 2018.

Hall PM. Prevention of Progression in Diabetic Nephropathy, Diabetes Spectrum. 2006;19(1):18-24.

Ahlawat R, Tiwari P, D'Cruz S. Direct Cost for Treating Chronic Kidney Disease at an Outpatient Setting of a Tertiary Hospital: Evidence from a Cross-Sectional Study. Value Health Reg Issues. 2017;12:36-40.

Rajput R, Kumar KMP, Seshadri K, Agarwal P, Talwalkar P, Kotak B, et al. Prevalence of Chronic Kidney Disease (CKD) in Type 2 Diabetes Mellitus Patients: START-India Study, Department of Endocrinology, PGIMS, Rohtak, Haryana, India. J Diabetes Metab. 2017;8(2):1000722.

Schwandt A, Denkinger M, Fasching P, Pfeifer M, Wagner C, Weiland J, et al. Comparison of MDRD, CKD-EPI, and Cockcroft-Gault equation in relation to measured glomerular filtration rate among a large cohort with diabetes. J Diabetes Complications. 2017;31(9):1376-83.

Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD. Am J Kidney Dis. 2014;63(5):713-35.

Wu B, Bell K, Stanford A, Kern DM, Tunceli O, Vupputuri S, et al. Understanding CKD among patients with T2DM: prevalence, temporal trends, and treatment patterns- NHANES 2007–2012. BMJ Open Diabetes Res Care. 2016;4:e000154.

Rodriguez-Poncelas A, Garre-Olmo J, Franch-Nadal J, Diez-Espino J, Mundet-Tuduri X, Barrot-De la Puente J, et al. Prevalence of chronic kidney disease in patients with type 2 diabetes in Spain: PERCEDIME2 study. BMC Nephrol. 2013;14:46.

Sahay R, Kalra S, Agarwal N, Baruah MP, Bandgar T, Bantwal GM, et al. PO162 burden of chronic kidney disease among type 2 diabetics in India. Diabetes Res Clin Pract. 2014;106(1):130.

Bailey RA, Wang Y, Zhu V, Marcia FT. Rupnow Chronic kidney disease in US adults with type 2 diabetes: an updated national estimate of prevalence based on Kidney Disease: Improving Global Outcomes (KDIGO) staging. BMC Res Notes. 2014;7:415.

Gatwood J, Chisholm-Burns M, Davis R, Thomas F, Potukuchi P, Hung A, et al. Evidence of chronic kidney disease in veterans with incident diabetes mellitus. PLoS ONE. 2018;13(2):e0192712.

Zoppini G, Targher G, Chonchol M, Ortalda V, Negri C, Stoico V, et al. Predictors of Estimated GFR Decline in Patients with Type 2 Diabetes and Preserved Kidney Function. Clin J Am Soc Nephrol. 2012;7(3):401–8.

Yu MK, Katon W, Young BA. Associations between sex and incident chronic kidney disease in a prospective diabetic cohort. Nephrol. 2015;20(7):451–8.

The Role of Gender in Chronic Kidney Disease | Chronic Kidney Disease, Renal Function. Scribd. Available at: https://www.scribd.com/document/ 347994726/. Accessed on 3 March 2018.

Hong D, Oh IH, Park JS, Lee CH, Kang CM, Kim GH. Evaluation of Urinary Indices for Albuminuria and Proteinuria in Patients with Chronic Kidney Disease. Kidney Blood Press Res. 2016;41:258-66.

Pecoits-Filho R, Abensur H, Betônico CCR, Machado AD, Parente EB, Queiroz M, et al. Interactions between kidney disease and diabetes: dangerous liaisons. Diabetol Metab Syndr. 2016;8:50.

The Role of Gender in Chronic Kidney Disease | Chronic Kidney Disease, Renal Function. Scribd. Available from: https://www.scribd.com/document/ 347994726/The-Role-of-Gender-in-Chronic-Kidney-Disease. Accessed on 10 January 2010.

Rajput R, Kumar KMP, Seshadri K, Agarwal P, Talwalkar P, Kotak B, et al. Prevalence of Chronic Kidney Disease (CKD) in Type 2 Diabetes Mellitus Patients: START-India Study. J Diabetes Metab. 2017;8(2):2–5.