A study of prevalence of chronic kidney disease in type II diabetes mellitus patients at a tertiary health care centre

 

 

Abstract              Background: CKD is seen in majority of the patients of diabetes milletus. CKD increases the frequency of cardiovascular disease episodes and progresses to end-stage renal disease (ESRD). Aim and objective: To study the prevalence of chronic kidney disease in type II diabetes mellitus patients at a tertiary health care centre Methodology: Present study was a prospective study carried out in diabetic clinic at tertiary health care centre. Study population was diagnosed cases of type II diabetes mellitus visiting diabetic clinic at a tertiary health care centre. Data was collected with pre tested questionnaire. Patients were considered as having CKD when they have low eGFR ((<60 ml/min/1.73 m2) and /or increased ACR (≥ 30 mg/g or ≥ 3 mg/mmol). Stages of CKD were determined according to KDQOI (Kidney Disease Outcomes Quality Initiative) guidelines. Results: Mean age of the patient in our study was 48.25±4.6 years. Male to female ration in our study was 1.17:1. Mean serum creatnine was 1.2±0.4 mg/dl Mean urine creatinine was 98.6± 13.27 mg/dl and Mean urine albumin was 134.5± 68.31 mg/l. In our study we found that prevalence of CKD in type II diabetes milletus was 51.3%. Mean GFR of the patient was 78.41± 17.11 ml/min/1.73 m2. Mean ACR of the patient was 113± 24.5 mg/g.

Key Word: chronic kidney disease, DM.

 

INTRODUCTION

Diabetes milletus is an endocrine disorder affecting multiple organs. Type II diabetes milletus commonly seen in persons above 40 years. It is known as non insulin dependent diabetes milletus. Chronic kidney disease is a slow and progressive loss of kidney function over a period of several years. CKD patients usually have few or no symptoms, especially in the earlier stages, so many of the patients are not aware that they have the disease. Risk factors for CKD include diabetes, hypertension and specific kidney diseases like polycystic kidney disease. Diabetes and hypertension, are responsible for up to two-thirds of the cases. CKD is classified into five stages based on the level of GFR.¹ Stage 1 refers to the mildest stage of CKD while stage 5 indicates kidney failure. Kidney damage is assessed using albuminuria and using the albumin-to-creatinine ratio (ACR) Various studies in past indicate Diabetes milletus and hypertension as important risk factors in development of CKD. In a study conducted in the USA, diabetes and hypertension were responsible for more than 50% of cases of End Stage Renal Disease², and in a study conducted in Khuzestan, Iran, diabetes was the most common cause of disease and glomerulonephritis was responsible for about 10% of cases.³ Due to higher prevalence and lack of symptoms in earlier phase early detection of CKD is very important. This study was conducted to find the prevalence of CKD in type II Diabetes milletus patients

 

METHODOLOGY

Present study was a prospective study carried out in diabetic clinic at tertiary health care centre. Study population was diagnosed cases of type II diabetes mellitus visiting diabetic clinic at a tertiary health care centre. Inclusion criteria: 1. Patients diagnosed as type II diabetes mellitus. 2. Patients above 18 years Exclusion criteria: 1. Patients below 18 years 2. Pregnant woman3.patients with type I diabetes mellitus, acute kidney injury 4. Patients with renal transplant or patients on dialysis 5. Patients not willing to participate Present study was approved by ethical committee. A written valid consent was taken from the patients after explaining study to them. Data was collected with pre tested questionnaire. Data included sociodemographic data like age, sex, socioeconomic status. Detailed history of the patient was taken. Through clinical examination was done. All patients underwent laboratory investigations like HbA1C, kidney function tests and routine urine analysis. Patients were considered as having CKD when they have low eGFR ((<60 ml/min/1.73 m2) and /or increased ACR (≥30 mg/g or ≥3 mg/mmol). Stages of CKD were determined according to KDQOI (Kidney Disease Outcomes Quality Initiative) guidelines.⁴ ACR was calculated from creatinine in urine and microalbuminuria result. GFR was calculated by Modification of Diet in Renal Disease (MDRD) equation.⁵ Data was analysed with appropriate statistical tests.

 

RESULTS

We studied 1000 patients. Table 1 shows distribution of patients according to age group. Majority of the patients were in the age group of 51-60 years (37%) followed by 41-50 years. In the age group of 31-40 years there were 11% patients. Patients above age of 60 years contributed 22% of all. Mean age of the patient in our study was 48.25±4.6 years. In our study we found that out of total 1000 patients 540 were males and 460 were females. Male to female ration in our study was 1.17:1. Table 2 shows baseline characteristics of the enrolled patients. mean weight of the patients was 72.3± 4.2 kgs. Mean waist circumference was 98± 7.4 cm and mean BMI was 29.3± 2.8 kg/m2. Duration of diabetes varies in our patients. Mean duration of diabetes was 8.3±2.1 years. Duration ranged from 10 months to 20 years. We carried out blood investigations like HBA1c (glycated hemoglobin) and serum creatinine to assess the blood sugar level and renal status. Mean HBA1c was 8.7±1.1. Mean serum creatnine was 1.2±0.4 mg/dl. To analyse the CKD stage we performed urine creatinine and urine albumin. Mean urine creatinine was 98.6± 13.27 mg/dl and Mean urine albumin was 134.5± 68.31 mg/l. In our study we found that prevalence of CKD in type II diabetes milletus was 51.3%. Table 3 shows distribution of patients according to categories of CKD. CKD was categorized according to GFR (Glomerular Filteration Rate) and ACR (albumin creatnine ratio). GFR values considered for categorization were G1- ≥90 ml/min/1.73 m2, G2-60-89 ml/min/1.73 m2, G3a - 45-59 ml/min/1.73 m2, G3b-30-44 ml/min/1.73 m2, G4 - 15-29 ml/min/1.73 m2 and G5 - <15 ml/min/1.73 m2. ACR values according to category were A1 - <30 mg/g, A2 - 30-300 mg/g and A3 - >300 mg/g. Mean GFR of the patient was 78.41± 17.11 ml/min/1.73 m2. Mean ACR of the patient was 113± 24.5 mg/g. In our study GFR was mildly decreased in 46.2% patients. It was normal to high in 29.7% individuals and mild to moderately decreased in 12.7% individuals. Kidney failure was observed in 9 patients (0.9%). ACR was normal to mildly increased in 61.8% patients. it was moderately increased in 27.4% patients and severely increased in 10.8% patients.

 

Table 1: Distribution of type II diabetes milletus patients according to age group

 

Figure 1: distribution of type II diabetes milletus patients according to sex

 

Table 2: Baseline characteristics of the patients with type II diabetes milletus

Table 3: Distribution of diabetic patients according to categories of CKD

 

DISCUSSION

We studied 1000 patients. Majority of the patients were in the age group of 51-60 years (37%) followed by 41-50 years. Male to female ration in our study was 1.17:1. Mean urine creatinine was 98.6±13.27 mg/dl and Mean urine albumin was 134.5±68.31 mg/l. Mean GFR of the patient was 78.41±17.11 ml/min/1.73 m2. Mean ACR of the patient was 113±24.5 mg/g. In our study we found that prevalence of CKD in type II diabetes milletus was 51.3%. In our study GFR was mildly decreased in 46.2% patients. It was normal to high in 29.7% individuals and mild to moderately decreased in 12.7% individuals. Kidney failure was observed in 9 patients (0.9%). ACR was normal to mildly increased in 61.8% patients. it was moderately increased in 27.4% patients and severely increased in 10.8% patients. Previous studies showed different prevalence of CKD in type II diabetes milletus. In a study by Vinagre et al they found prevalence of 20% for RI and 16.7% for albuminuria.⁶ In a study by van der Meer et al⁷ observed that 27.6% of DM2 patients had CKD and that 13.6% of these DM2 patients had albuminuria. In a study by Plantinga et al⁸ it was observed that 32.9% of U.S population had CKD and that 19.4% of these patients had albuminuria. In another study by Lou Arnal et al⁹ they found 34.5% of the patients with diabetes milletus have CKD. 16.1% of patients had albuminuria. and 9.4% of the patients with eGFR ≥ 60 ml/min/1.73 m2 had albuminuria. In a study by New JP et al ¹⁰ it was seen that 31% of diabetic patients had a GFR<60ml/min/1.73 m2 and 37% of these patients had albuminuria. Thomas et al.¹¹ observed that 23.1% of DM2 patients had a GFR < 60 ml/min/ 1.73 m2 and that 34.6% of these patients had albuminuria (27.3% microalbuminuria and 7.3% macroalbuminuria). Pugliese et al¹² found that the prevalence of RI was 18.7% and CKD 37.5% with the MDRD Study equation.

 

CONCLUSION

HIgher prevalence of CKD in type II diabetes milletus patients signifies early screening of renal function tests in diabetic patients.

 

REFERENCES

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