Prevalence of risk factors associated with progression of nephropathy in diabetic patients with chronic renal insufficiency as seen at Kenyatta National Hospital

Abstract

Background: Forty-five percent of new cases of end stage renal disease in the USA result from diabeticnephropathy. The absolute number and proportion of kidney failure cases caused by diabetesisexpected to rise dramatically as the prevalence of diabetes mellitus increases over the nextdecadebecause ofan epidemic of obesity. Diabeticpatients with chronic kidney disease pose unique problems different from the rest of the chronicrenal insufficiency population. Several studies have shown that diabetics enter into renal replacementprograms earlier since they are not able to tolerate uraemia as well as non-diabetic renalpatients. They have more difficult vascular access due to accelerated artherosclerosis and theyhave poorer outcome due to higher cardiovascular complications, which are also the major cause of death pre and post-dialysis They require special attention at renal transplantation: meticulous glucose control, more difficult surgery because of artherosclerosis, and higher incidenceof complication due to immunosuppressive therapy and artherosclerosis. The annual costfor dialysis in a diabetic patient is more than for non-diabetic patient and diabetic dialysis and transplant recipients have higher mortality and morbidity. More importantly, renal replacement therapy (RRT) is very expensive. Many type 2 diabetics are elderly, have much comorbidity and are not transplantable by the time they reach end stage renal failure. Therefore, it isextremely important to delay or stop progression to ESRD. Several studies have shown that modification of specific risk factors can retard or halt progression of CKD, depending on when these measures are introduced in the management. No data existed on the prevalence of risk factors associated with progression of nephropathy in diabetic patients at KNH.