Alemu Hailemaryam, Hailu Workagegnehu, Adane Aynishet
Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar City, Ethiopia.
Curr Ther Res Clin Exp. 2020 Feb 26;92:100578. doi: 10.1016/j.curtheres.2020.100578. eCollection 2020.
Chronic kidney disease (CKD) is increasingly recognized as a global health issue and it affects 10% to 15% of the world population. Diabetes mellitus is the leading cause of end-stage renal disease. More than 422 million adults in the world populations are living with diabetes mellitus, 40% of whom will develop CKD. CKD in diabetes increases the risk of early death and cardiovascular morbidity and mortality. There is a paucity of published data on the prevalence of CKD and its associated factors among patients with diabetes in northwest Ethiopia.
The aim of this study is to determine the prevalence and factors associated with CKD among patients with diabetes at University of Gondar Hospital, Northwest Ethiopia.
A hospital-based cross-sectional study was conducted from April 2 to July 31, 2018. Using convenience sampling, a total of 272 consecutive patients with diabetes were recruited for the study. Data regarding the patients' sociodemographic information, clinical characteristics, and laboratory parameters were collected using patient interview and review of medical records. Serum creatinine was measured and used to calculate estimated glomerular filtration rate using modification of diet in renal disease and chronic kidney disease epidemiology equations. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression analyses were used to identify predictors of CKD in patients with diabetes.
The prevalence of CKD, defined by estimated glomerular filtration rate <60 mL/min/1.73 m, was found to be 17.3% and 14.3% by modification of diet in renal disease and chronic kidney disease epidemiology equations, respectively. The proportion of stage 3 CKD by modification of diet in renal disease equation was 14.7%, whereas the proportions of stage 4 and stage 5 CKD were 2.2% and 0.4%, respectively. Among those who were diagnosed with CKD, 85.1% had pre-existing hypertension. Multivariate logistic regression analysis revealed that the presence of retinopathy (adjusted odds ratio = 14; 95% CI, 4-36; < 0.001), pre-existing hypertension (adjusted odds ratio = 8.2; 95% CI, 2-23; < 0.001), current systolic blood pressure >140 mm Hg (adjusted odds ratio = 6; 95% CI, 4-22; = 0.001), and duration of diabetes >10 years (adjusted odds ratio = 3.2; 95% CI, 2-7; = 0.004) were significantly associated with CKD in patients with diabetes.
The prevalence of CKD in patients with diabetes is high and comparable with previous studies from low- and middle-income countries. Pre-existing hypertension, current systolic blood pressure >140 mm Hg, duration of diabetes >10 years, and presence of retinopathy were significantly associated with CKD. Regular screening for CKD, retinopathy, and optimal blood pressure management should be practiced.
慢性肾脏病（CKD）日益被视为一个全球健康问题，影响着全球10%至15%的人口。糖尿病是终末期肾病的主要病因。全球超过4.22亿成年人患有糖尿病，其中40%会发展为CKD。糖尿病患者中的CKD会增加早死风险以及心血管疾病的发病率和死亡率。在埃塞俄比亚西北部，关于糖尿病患者中CKD患病率及其相关因素的已发表数据匮乏。
本研究的目的是确定埃塞俄比亚西北部贡德尔大学医院糖尿病患者中CKD的患病率及其相关因素。
2018年4月2日至7月31日进行了一项基于医院的横断面研究。采用便利抽样法，共纳入272例连续的糖尿病患者进行研究。通过患者访谈和病历回顾收集患者的社会人口学信息、临床特征和实验室参数数据。测量血清肌酐，并使用肾脏病饮食改良方程和慢性肾脏病流行病学方程计算估计肾小球滤过率。使用SPSS 20版进行数据分析。采用二元和多元逻辑回归分析来确定糖尿病患者中CKD的预测因素。
根据估计肾小球滤过率<60 mL/min/1.73 m²定义的CKD患病率，采用肾脏病饮食改良方程和慢性肾脏病流行病学方程分别为17.3%和14.3%。采用肾脏病饮食改良方程，3期CKD的比例为14.7%，而4期和5期CKD的比例分别为2.2%和0.4%。在诊断为CKD的患者中，85.1%既往有高血压。多元逻辑回归分析显示，视网膜病变（调整优势比=14；95%可信区间，4 - 36；<0.001）、既往有高血压（调整优势比=8.2；95%可信区间，2 - 23；<0.001）、当前收缩压>140 mmHg（调整优势比=6；95%可信区间，4 - 22；=0.001）以及糖尿病病程>10年（调整优势比=3.2；95%可信区间，2 - 7；=0.004）与糖尿病患者的CKD显著相关。
糖尿病患者中CKD的患病率较高，与来自低收入和中等收入国家的既往研究相当。既往有高血压、当前收缩压>140 mmHg、糖尿病病程>10年以及存在视网膜病变与CKD显著相关。应定期筛查CKD、视网膜病变并进行最佳血压管理。
