Wudu Muluken Amare, Birhanu Tarikua Afework, Tegegne Kirubel Dagnaw, Wondifraw Endalik Birrie
Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, P. O. Box: 1145, Dessie, 1145, Ethiopia.
Department of Adult Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, 1145, Ethiopia.
BMC Endocr Disord. 2025 Aug 1;25(1):190. doi: 10.1186/s12902-025-02006-y.
Diabetic kidney disease is a leading cause of end-stage renal disease and mortality among patients with type 2 diabetes mellitus worldwide. Currently, there are no pooled estimates of the incidence of diabetic kidney disease or its modifiable predictors among patients with type 2 diabetes mellitus in Ethiopia. Therefore, this review aimed to determine the pooled incidence and associated factors of diabetic kidney disease in Ethiopia, addressing the existing information gap.
Relevant studies were retrieved from PubMed, Scopus, EMBASE, and Google Scholar. Four reviewers independently screened studies, and data were extracted using a structured form. Quality assessment was conducted using the Joanna Briggs Institute critical appraisal checklist. Data analysis was performed in STATA version 17 using the Šidák-Jonkman random-effects model. Heterogeneity was evaluated using Cochrane's Q-test and the I² statistic, while publication bias was assessed using funnel plots, Egger's test, and a Doi plot.
Of the 165,230 studies identified, eight studies involving 3,703 participants were included in the meta-analysis. The pooled incidence of diabetic kidney disease among patients with type 2 diabetes mellitus was 2.37 per 100 person-years (95% CI: 1.76-2.97; I² = 99.85%), based on 29,916.35 person-years of observation. Moreover, study setting and follow-up period (R²=83.21%) were considered as the source of heterogeneity. Furthermore, the pooled median time to develop diabetic kidney disease was 101.38 months (95% CI: 72.79-129.97). Factors associated with diabetic kidney disease included older age (> 60 years) (HR: 1.02, 95% CI: 1.01-1.03), hypertension (HR: 2.07, 95% CI: 1.83-2.34), cardiovascular disease (HR: 1.53, 95% CI: 1.29-1.81), and low high-density lipoprotein cholesterol (HDL-C) levels (< 40 mg/dL) (HR: 1.70, 95% CI: 1.42-2.05).
The incidence of diabetic kidney disease in this review was high, highlighting the need for intensified efforts to achieve the 2030 kidney health target and improve patients' quality of life. Moreover, older age, hypertension, cardiovascular disease, and low HDL-C levels were identified as risk indicators of diabetic kidney disease. This suggests strengthening early routine risk-based screening, especially in older adults, and implementing intensive management of hypertension, cardiovascular disease, and dyslipidemia to address the identified factors.
糖尿病肾病是全球2型糖尿病患者终末期肾病和死亡的主要原因。目前，埃塞俄比亚2型糖尿病患者中糖尿病肾病的发病率及其可改变的预测因素尚无汇总估计。因此，本综述旨在确定埃塞俄比亚糖尿病肾病的汇总发病率及相关因素，以填补现有信息空白。
从PubMed、Scopus、EMBASE和谷歌学术中检索相关研究。四名评审员独立筛选研究，并使用结构化表格提取数据。使用乔安娜·布里格斯研究所的批判性评价清单进行质量评估。使用Šidák-Jonkman随机效应模型在STATA 17版中进行数据分析。使用Cochrane的Q检验和I²统计量评估异质性，使用漏斗图、Egger检验和Doi图评估发表偏倚。
在165,230项识别出的研究中，八项研究涉及3,703名参与者被纳入荟萃分析。基于29,916.35人年的观察，2型糖尿病患者中糖尿病肾病的汇总发病率为每100人年2.37例（95%置信区间：1.76 - 2.97；I² = 99.85%）。此外，研究环境和随访期（R² = 83.21%）被认为是异质性的来源。此外，发生糖尿病肾病的汇总中位时间为101.38个月（95%置信区间：72.79 - 129.97）。与糖尿病肾病相关的因素包括老年（＞60岁）（风险比：1.02，95%置信区间：1.01 - 1.03）、高血压（风险比：2.07，95%置信区间：1.83 - 2.34）、心血管疾病（风险比：1.53，95%置信区间：——1.29 - 1.81）和低高密度脂蛋白胆固醇（HDL-C）水平（＜40mg/dL）（风险比：1.70，95%置信区间：1.42 - 2.05）。
本综述中糖尿病肾病的发病率很高，突出了为实现2030年肾脏健康目标和改善患者生活质量而加大努力的必要性。此外，老年、高血压、心血管疾病和低HDL-C水平被确定为糖尿病肾病的风险指标。这表明应加强早期基于风险的常规筛查，尤其是在老年人中，并对高血压、心血管疾病和血脂异常实施强化管理，以应对已确定的因素。
