Evaluation of risk factors associated with nephropathy in type 2 diabetic patients in Rwanda
Abstract
Background: Diabetic nephropathy is an emerging clinical and public problem and is related with poor outcomes such as heart failure, and end stage renal disease. In the Rwanda countryside there are no recent studies on renal complications.
Objective: To evaluate risk factors associated with nephropathy in Type 2 diabetic patients in Rwanda.
Methods: A case-control study was conducted from January to September 2019 in four hospitals of Republic of Rwanda. Diabetic patients were screened for nephropathy by measuring microalbuminuria. Those with microalbuminuria were the cases and those patients free of nephropathy were the controls. The study sample had 592 participants, 83 cases and 509 controls enrolled. Plasma glucose was measured by enzymatic colorimetric test. HbA1c test was performed using the unique procedure of Bio -Rad Variant II. Albuminuria was measured by quantitative method using spectrophotometer. Total plasma cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, Urea and Creatinine were assayed by colorimetric methods using commercial kits. A questionnaire was used to assess other risk factors such as alcohol consumption, smoking, level of physical activity, family history of T2DM, obesity, stress, and demographic status. The data was analyzed on SPSS version 20. Statistical analysis was performed by Chi square to show association in nominal and ordinal data. Multivariate logistic regression analysis to select independent variables was performed. Odds ratio was used as measure of association.
Results: In this study the prevalence of Diabetic nephropathy was 14%, (microalbuminuria was 12.5% and macroalbuminuria 1.5%). The major independent risk factors associated with diabetic nephropathy were male gender, long duration of type 2 diabetes (≥16 years), elevated HbA1c (> 7.5%) , poor adherence to diabetic medication, elevated creatinine (> 1.2 mg/dl), and lower level of education.
Conclusion: Management of those modifiable risk factors of nephropathy could reduce its incidence in diabetic patients.
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Introduction
Type 2 Diabetes mellitus (T2DM) is a syndrome characterized by persistent hyperglycemia and other abnormalities of metabolism, resulting from defective insulin secretion by the pancreas, insulin action, or sometimes both [1].
Diabetes is the single major cause of chronic kidney disease leading to the end-stage renal disease (ESRD) [2]. Diabetic nephropathy (DN) is an emerging clinical and public problem and is related with poor outcomes such as heart failure, and ESRD [3]. Deaths related to these severe complications decrease life expectancy [4] in particular in most African countries [3].
DN is the cause of about 40% of end-stage renal disease in USA and Europe. Clinically DN is characterized by albuminuria (> 300 mg/day or 200 μg/min), decreased glomerular filtration rate (GFR) [2] and hypertension. Microalbuminuria (MA) is considered to be an early marker of DN and predictor for cardiovascular disease [4]
Conclusion
The prevalence of diabetic nephropathy based on levels of microalbuminuria in this study was 14% in type 2 diabetic patients. The major independent risk factors associated with diabetic nephropathy were male gender, long duration of disease, elevated glycosylated hemoglobin, poor adherence to diabetic medication, elevated creatinine, lower level of education and positive C- Reactive – Protein. It is expected that the management of these modifiable risk factors of diabetic nephropathy shall help significantly reduce its incidence or delay its onset thus impacting positively the quality of life of diabetic patients.