A Cross-Sectional Study for Prevalence and Association of Risk Factors of Chronic Kidney Disease Among People With Type 2 Diabetes in the Indian Setting.

Ajoy Tewari,Jay Tewari,Vineeta Tewari

doi:10.7759/cureus.18371

Abstract

Introduction: Current evidence demonstrates that people with type 2 diabetes (T2D) are at a higher risk of developing chronic kidney disease (CKD) with greater morbidity and mortality. We, therefore, aimed to document and categorize demographic, anthropometric, and physiological risk factors of CKD in people with T2D in India. Additionally, we also attempted to evaluate the magnitude of each risk factor, namely age, duration of diabetes, HbA1c, and body mass index (BMI) in its etiology.Methods: This observational, single-center, and cross-sectional study was performed at a diabetes care center in Lucknow, India. Out of a total of 504 eligible patients, we could get the required data from 435 patients. The following data were collected: demographic data, estimated glomerular filtration rate (eGFR), serum creatinine, urinary albumin creatinine ratio (UACR), and HbA1c levels. Appropriate statistical tests were applied.Result: The 435 eligible people with diabetes had a mean age (SD) of 51 (±10.52) years; female 48.02%, duration of diabetes 7 (±5.4) years; HbA1c 8.6 (±2.3)% and eGFR values 80.2 (±26.6) mL/min/1.73m2 at the time of presentation. The eGFR values correlated negatively with age and duration of diabetes, and positively with increasing BMI. The Spearman correlation coefficient showed that clinical parameters such as age, duration of diabetes, and BMI have a weak, but statistically significant correlation with eGFR while eGFR did not correlate with HbA1c level in the study. Further, we did not find a correlation between eGFR and UACR.Conclusion: In people with T2D, age and duration of diabetes are important risk factors for the development of CKD based on the eGFR. Hence, even in the absence of high UACR values, a low eGFR should prompt periodic monitoring to reduce the risk of progression of CKD, especially, in older people with long-standing T2D. Our study did not find HbA1c as a suitable tool to assess the CKD progression risk, but historical glycaemic control over longer periods revealed by sequential values of HbA1c over the duration of disease may correlate with the progression of CKD.

Highlights

Current evidence demonstrates that people with type 2 diabetes (T2D) are at a higher risk of developing chronic kidney disease (CKD) with greater morbidity and mortality
EGFR - estimated glomerular filtration rate the eGFR was found to be significantly decreasing with increasing duration of diabetes (p=0.003) (Figure 2)
The present study provides consistent and recent epidemiological data showing an inverse association of eGFR with age and duration of diabetes, while it correlated with body mass index (BMI) among people with T2D

Summary

Introduction

Current evidence demonstrates that people with type 2 diabetes (T2D) are at a higher risk of developing chronic kidney disease (CKD) with greater morbidity and mortality. One of the key complications of T2D is chronic kidney disease (CKD). The Third National Health and Nutrition Examination Survey (NHANES III) across 10 years, which determined cumulative mortality by diabetes and kidney disease status in over 15,000 participants, showed that those with kidney disease largely accounted for the increased mortality in people with T2D [4]. The presence of kidney disease accounts for the increased mortality in people with T2D. The presence of CKD increases the risk of all-cause and cardiovascular mortality in people with diabetes [4]. There are several factors that can increase the risk for CKD namely age, gender, race/ethnicity, and family history along with hyperglycemia, hypertension, and cardiovascular disease. A meta-analysis determining associations of kidney disease parameters with mortality and end-stage renal disease (ESRD) in individuals with diabetes has shown that the addition of eGFR and urinary albumin-to-creatinine ratio (UACR) significantly improved the prediction of

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