Nephropathy among type II diabetes at a rural health centre, Goa, India
Keywords:Diabetes mellitus, Microalbuminuria, Nephropathy, Correlates
Background: Diabetes mellitus and chronic kidney disease is a dreadful combination. India has the world’s largest population suffering from diabetes mellitus and is predicted to rise to almost 70 million by the year 2025 which would make India vulnerable to complications like diabetic nephropathy leading to end stage renal disease. The study was conducted at a rural health centre with the aim to study and assess Type II diabetes mellitus for nephropathy.
Methods:A case series study comprising 241 Type II diabetes mellitus patients above 18 years of age on treatment were included. Patients with UACR equal to or above 30-μg/mg creatinine were subjected to ophthalmoscopy to detect Retinopathy. Microalbuminuria with retinopathy is diagnostic of nephropathy. Further, with serum creatinine, estimated glomerular filtration rate (eGFR) was calculated using cockcraft gault equation and nephropathy was graded as per NKF- KDOQI “clinical guidelines for CKD”, Statistical analysis was done using SPSS version 22. Fisher’s exact and Student‘t’ tests were used.
Results: Out of total 241 subjects, 49 i.e. 20.3% were found to have microalbuminuria. Forty -two patients i.e. 17.4% had retinopathy with microalbuminuria hence prevalence of diabetic nephropathy in this study was 17.4%. Correlates including older age, duration of diabetes, tobacco smoking, hazardous drinking, missed medication, serum creatinine and HbA1c levels were found to be significantly associated with nephropathy. Fifty percent of the diabetic nephropathy patients had Grade III Nephropathy, while 42.8% had Grade II and 7.14% Grade I.
Conclusions:Effective screening programme at primary care level can help detect nephropathy early, delay progression to end stage renal disease (ESRD) and reduce cardiovascular mortality.
Bethesda MD. United States Renal Data Resource Systems (USRDS) - Annual data report. National Institute of Diabetes & Digestive & Kidney Diseases, National Institute of Health, US Department of Health and human services, 2007.
Deepa M, Pradeepa R, Rema M, Mohan A, Deepa R, Shanthirani S. et al. The Chennai Urban Rural Epidemiology study (CURES) – study design and methodology (Urban component) CURES. J Assoc Physicians India. 2003;51:863-70.
Abdul FB. Type II Diabetes and Rural India. Lancet. 2007;369:273-4.
Gupta SK, Singh Z, Purty AJ, Kar M, Vedapriya D, Mahajan P, et al. Diabetes prevalence and its risk factors in rural area of Tamil Nadu. Indian J Community Med. 2010;35:396-9.
Rajapurkar M, Dabhi M. Burden of disease - prevalence and incidence of renal disease in India. Clin Nephrol. 2010;74 Suppl 1:S9-12.
Seventh report of the Joint national Committee on Prevention, Detection, Evaluation and treatment of high blood pressure Hypertension. 2003;42:1206.
Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of Type 2 Diabetes: Indian scenario. Indian J med res. 2007;125:217-30.
Chow CK, Krishnam Raju P, Rama Raju, Reddy KS. The prevalence and management of Diabetes in Rural India. Diabetes care. 2006;29(7):1717-8.
American Diabetes Association: Nephropathy in Diabetes (position Statement) Diabetes Care. 2004;27(suppl.1):S79-83.
KDIGO 2012 Clinical practice guidelines for the evaluation and management of chronic kidney disease. 2013;3(1).
Verghese T. Diabetic nephropathy- Indian perspective. The Lancet. 2011;3:771-9.
World Health Organization booklet on Adherence, 2003.
WHO 2001.Alcohol use disorders identification test, 10 item instrument.
White SL, Polkinghorne KR, Cass A, Shaw JE, Atkins RC, Chadban SJ. Alcohol consumption and 5-year onset of chronic kidney disease: the AusDiab study. Nephrol Dial Transplant. 2009;24(8):2464-72.
Stephen R. Smoking and Kidney. Orth J am soc nephrol. 2002;13:1663-72.
Bash D, Selvin E, Steffes M, Coresh J, Astor BC. Poor glycemic control in diabetes and the risk of incident chronic kidney disease even in the absence of albuminuria and retinopathy: Atherosclerosis risk in communities (ARIC) Study. Arch Intern Med. 2008;168:2440-7.