Rwegerera Godfrey Mutashambara, Molefe-Baikai Onkabetse Julia, Masaka Anthony, Shimwela Meshack, Rivera Yordanka Pina, Oyewo Taibat Aderonke, Godman Brian B, Massele Amos, Habte Dereje
a Department of Internal Medicine , University of Botswana and Department of Medicine, Princess Marina Hospital , Gaborone , Botswana.
b Department of Public Health Management , Botho University , Gaborone , Botswana.
Hosp Pract (1995). 2018 Oct;46(4):214-220. doi: 10.1080/21548331.2018.1506674. Epub 2018 Aug 14.
Diabetes mellitus (DM) is one of the most common contributors of chronic kidney disease (CKD). The epidemiology of CKD, a concern among patients with DM, has not been studied in Botswana. Consequently, the objective of this study was to estimate its prevalence among these patients in Botswana to provide future guidance to both government personnel and physicians.
Observational cross-sectional study in a leading clinic in Botswana. Demographic and clinical data were obtained from patients through interviews and from their notes using a standard questionnaire. The study was conducted from July to October 2015. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet for Renal Disease equation. CKD was defined as an eGFR < 60 ml/min/1.73 m. Multivariable logistic regression analyses were performed to assess the associations between CKD and potential factors.
The mean age and duration of DM among study participants were 54.67 years (range 21-92 years) and 5.0 years, respectively. Over half, i.e. 213/370 (57.6%) and 232/370 (62.7%), had an average blood pressure greater than 140/90 mmHg and poor glycemic control (HbA1c > 7%), respectively. 31/370 patients (8.4%) had CKD. However, only 18/370 (4.9%) had a diagnosis of CKD documented in their charts. Age, level of education, and duration of diabetes were independently associated with CKD.
The prevalence of CKD by estimated eGFR was low compared to most previous studies. However, half of patients with CKD are not documented resulting in the potential for prescription errors and drug toxicity. A substantial number of our patients had uncontrolled hypertension and poor glycemic control. Older age, low level of education and longer duration of DM were associated with CKD. There is a need to carry out prospective studies to determine the association and role of glycemic and blood pressure control in CKD causation among patients with DM in Botswana.
糖尿病（DM）是慢性肾脏病（CKD）最常见的病因之一。博茨瓦纳尚未对糖尿病患者所关注的慢性肾脏病流行病学进行研究。因此，本研究的目的是估计博茨瓦纳这些患者中慢性肾脏病的患病率，为政府人员和医生提供未来指导。
在博茨瓦纳一家领先的诊所进行观察性横断面研究。通过访谈和使用标准问卷从患者病历中获取人口统计学和临床数据。该研究于2015年7月至10月进行。使用肾脏病饮食改良方程计算估计肾小球滤过率（eGFR）。慢性肾脏病定义为eGFR<60ml/min/1.73m²。进行多变量逻辑回归分析以评估慢性肾脏病与潜在因素之间的关联。
研究参与者的糖尿病平均年龄和病程分别为54.67岁（范围21 - 92岁）和5.0年。超过一半，即213/370（57.6%）和232/370（62.7%）的患者平均血压高于140/90mmHg，血糖控制不佳（糖化血红蛋白>7%）。31/370例患者（8.4%）患有慢性肾脏病。然而，只有18/370（4.9%）的病历中有慢性肾脏病的诊断记录。年龄、教育程度和糖尿病病程与慢性肾脏病独立相关。
与大多数先前研究相比，通过估计eGFR得出的慢性肾脏病患病率较低。然而，一半的慢性肾脏病患者没有记录，这可能导致处方错误和药物毒性。我们的大量患者存在高血压未控制和血糖控制不佳的情况。年龄较大、教育程度低和糖尿病病程较长与慢性肾脏病有关。有必要进行前瞻性研究，以确定血糖和血压控制在博茨瓦纳糖尿病患者慢性肾脏病病因中的关联和作用。
