Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Box 19676-00202, Nairobi, Kenya.
Division of Medicine, Kenyatta National Hospital, Box 20723-00202, Nairobi, Kenya.
BMC Nephrol. 2020 Feb 28;21(1):73. doi: 10.1186/s12882-020-1705-3.
Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and is a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that would optimize outcomes including forestalling progression to end-stage kidney disease. This study was conducted in a regional referral public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area.
A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over 5 months. Informed consent was obtained and clinical evaluation was done, a spot sample of urine obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Descriptive statistics for data summary and regression analysis were employed on SPSS v23.
A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0% (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age > 50 years, long duration with diabetes > 5 years and hypertension. Employment and paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status.
Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over 30 % of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.
2 型糖尿病患者的慢性肾脏病 (CKD) 会增加心血管风险状况和疾病，并且是进展为终末期肾病的强有力预测指标。鼓励早期诊断，以便转介至专科肾脏护理，以进行积极管理，从而优化结局，包括阻止进展为终末期肾病。本研究在肯尼亚中部的一家地区转诊公立卫生机构进行，该机构 2 型糖尿病的患病率很高。其目的是在主要居住在农村地区的 2 型糖尿病门诊患者中发现未确诊的慢性肾脏病负担。
在尼耶里县医院的门诊进行了横断面研究。在 5 个月内共招募了 385 名患者。获得了知情同意，并进行了临床评估，采集了尿液的随机样本进行白蛋白尿检测，采集了静脉血进行糖化血红蛋白、血脂和血清肌酐检测。使用 Cockroft-Gault 方程计算估计肾小球滤过率 (eGFR)。根据 KDIGO 标准对慢性肾脏病 (CKD) 进行分类。白蛋白尿报告为阳性或阴性。使用 SPSS v23 进行数据汇总和回归分析的描述性统计。
共有 385 名参与者纳入研究，其中 252 名（65.5%）为女性。CKD/KDIGO 第 3、4 和 5 期患者占 39.0%（95%CI 34.3-44.2），32.7%（95%CI，27.8-37.4）患者存在白蛋白尿。与慢性肾脏病/ KDIGO 第 3、4 和 5 期显著相关的危险因素是：年龄>50 岁、糖尿病病程>5 年和高血压。就业和相反，肥胖降低了患 CKD 的几率，可能是更好的社会经济地位的标志。
超过 30%的研究患者存在未被识别的 KDIGO 第 3、4 和 5 期 CKD。高血压、年龄>50 岁、糖尿病病程长等危险因素有助于识别那些发生 CKD 风险较高的患者，以便进行筛查和转介治疗。他们有进展为终末期肾病和心血管事件的高风险。在公立资助的医院进行慢性肾脏病筛查至关重要，因为可以提供护理。
