Nephropathy among type II diabetes at a rural health centre, Goa, India

Abstract

Background: Diabetes mellitus and chronic kidney disease is a dreadful combination. India has the world’s largest population suffering from diabetes mellitus and is predicted to rise to almost 70 million by the year 2025 which would make India vulnerable to complications like diabetic nephropathy leading to end stage renal disease. The study was conducted at a rural health centre with the aim to study and assess Type II diabetes mellitus for nephropathy. Methods: A case series study comprising 241 Type II diabetes mellitus patients above 18 years of age on treatment were included. Patients with UACR equal to or above 30-μg/mg creatinine were subjected to ophthalmoscopy to detect Retinopathy. Microalbuminuria with retinopathy is diagnostic of nephropathy. Further, with serum creatinine, estimated glomerular filtration rate (eGFR) was calculated using cockcraft gault equation and nephropathy was graded as per NKF- KDOQI “clinical guidelines for CKD”, Statistical analysis was done using SPSS version 22. Fisher’s exact and Student‘t’ tests were used. Results: Out of total 241 subjects, 49 i.e. 20.3% were found to have microalbuminuria. Forty -two patients i.e. 17.4% had retinopathy with microalbuminuria hence prevalence of diabetic nephropathy in this study was 17.4%. Correlates including older age, duration of diabetes, tobacco smoking, hazardous drinking, missed medication, serum creatinine and HbA1c levels were found to be significantly associated with nephropathy. Fifty percent of the diabetic nephropathy patients had Grade III Nephropathy, while 42.8% had Grade II and 7.14% Grade I. Conclusions: Effective screening programme at primary care level can help detect nephropathy early, delay progression to end stage renal disease (ESRD) and reduce cardiovascular mortality.