The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening

Abstract Background 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 manag...

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Main Authors: Frederick C. F. Otieno, Elijah N. Ogola, M. W. Kimando, Kenn Mutai
Format: Article
Language:English
Published: BMC 2020-02-01
Series:BMC Nephrology
Online Access:http://link.springer.com/article/10.1186/s12882-020-1705-3
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spelling doaj-4e7a831e2cf243cd9813f18da9c992ed2020-11-25T00:28:07ZengBMCBMC Nephrology1471-23692020-02-0121111110.1186/s12882-020-1705-3The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screeningFrederick C. F. Otieno0Elijah N. Ogola1M. W. Kimando2Kenn Mutai3Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of NairobiDepartment of Clinical Medicine and Therapeutics, College of Health Sciences, University of NairobiDepartment of Clinical Medicine and Therapeutics, College of Health Sciences, University of NairobiDivision of Medicine, Kenyatta National HospitalAbstract Background 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. Methods 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. Results 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. Conclusion 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.http://link.springer.com/article/10.1186/s12882-020-1705-3
collection DOAJ
language English
format Article
sources DOAJ
author Frederick C. F. Otieno
Elijah N. Ogola
M. W. Kimando
Kenn Mutai
spellingShingle Frederick C. F. Otieno
Elijah N. Ogola
M. W. Kimando
Kenn Mutai
The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening
BMC Nephrology
author_facet Frederick C. F. Otieno
Elijah N. Ogola
M. W. Kimando
Kenn Mutai
author_sort Frederick C. F. Otieno
title The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening
title_short The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening
title_full The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening
title_fullStr The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening
title_full_unstemmed The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening
title_sort burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in kenya: implications to care and need for screening
publisher BMC
series BMC Nephrology
issn 1471-2369
publishDate 2020-02-01
description Abstract Background 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. Methods 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. Results 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. Conclusion 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.
url http://link.springer.com/article/10.1186/s12882-020-1705-3
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