The burden of chronic kidney disease in ambulant type 2 diabetes patients at Kenyatta national hospital diabetes outpatient clinics

Abstract

Background and Purpose-Chronic Kidney Disease (CKD) affects between 20 to 40% of patients with type 2 diabetes. The burden of chronic kidney disease in our ambulatory patients with type 2 diabetes here in Kenyatta National Hospital is unknown. This study aimed to look at the prevalence of CKD and risk factors associated with CKD in ambulatory type 2 diabetes. Objective- To determine the prevalence of CKD and diabetes glomerulopathy in ambulant type 2 diabetes patients attending the KNH outpatient diabetes clinics. Design – A cross-sectional descriptive study. Setting - Kenyatta National Hospital Diabetes outpatient clinic. Subjects – Two hundred ambulatory patients with type 2 diabetes, asymptomatic for kidney disease, on follow-up in the outpatient clinic were recruited into the study. Sampling– Systematic random sampling. Methods – Patients were recruited into the study by systematic random sampling. History was taken to obtain socio-demographic data, duration of diabetes, smoking habit, occurrence of cardiovascular disease, lower urinary tract symptoms. Physical examination included measurement of weight, height, BP, clinical cardiovascular examination. Their estimated GFR was calculated using the MDRD formula while albuminuria was quantified. Data management and analyses- Statistical analysis was done using STATA version 12. Descriptive statistics was presented using percentages and frequencies for categorical or nominal data while mean, standard deviation, median, minimum and maximum for continuous/discrete variables. The prevalence of CKD was calculated as the percentage of ambulant type 2 diabetes patients detected to have decreased eGFR and/or albuminuria. Results –The prevalence of CKD in ambulatory type 2 diabetes patients was found to be 54.5%. Less than half, 45% were found to have diabetic glomerulopathy. 78.5% of the patients were found to have low- to moderate risk of adverse cardiovascular outcome. 21.5% of the patients were found to have a high to very-high risk of adverse cardiovascular outcomes. Age and systolic BP were significantly related to CKD. Conclusion– There is a high prevalence of CKD in ambulatory asymptomatic type 2 diabetes patients. Over 20% of type 2 diabetes patients with CKD are at a high or very high risk of adverse cardiovascular outcomes. Hypertension is the most important modifiable risk factor for patients with CKD. Risk stratification of patients is important and should be part of routine care to facilitate interventions to mitigate adverse outcomes.