Prevalence and risk factors of chronic kidney disease in Palestinian patients with diabetes: a cross-sectional study

Abstract

BackgroundChronic kidney disease (CKD) is a worldwide public health problem because of high morbidity and mortality and high costs of treatment. Diabetes is a major risk factor for development and progression of CKD. In this study, we aimed to assess the prevalence of CKD among patients with type 2 diabetes treated in primary health care (PHC) centres in the north area of West Bank, occupied Palestinian territory. MethodsA cross-sectional study design was used. A sample size of 385 patients was calculated based on following sample size formula n=Z2 × P × (1 – P)/d2, where p is the expected CKD prevalence and d is the margin of error. All patients with diabetes are referred to their district's PHC clinics for follow-up and management, with 25·35 patients being seen per day. Patients eligible for this study had type 2 diabetes, were 18 years or older. Those with type 1 diabetes or gestational diabetes, women who were pregnant, and those who did not have at least two creatinine measurements at least 3 months apart were excluded from the study. Patients were recruited at random. Between September and December, 2018, every third patient on a given day's client list was chosen. Data were obtained from personal interviews with patients and from their electronic health records Collected data included patients’ characteristics, creatinine levels, blood pressure, glycated haemoglobin A1c (HbA1c), and duration of hypertension and diabetes. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was staged according to the Kidney Disease Improving Global Outcomes System 2012 guidelines. We did univariate and multivariate analyses in SPSS version 20. The threshold for significance was p<0·05. The study was approved by Al-Najah National University Institutional Review Board and the Palestinian Ministry of Health. Patients provided written informed consent. FindingsWe recruited 386 patients with diabetes (192 [50%] men, 194 [50%] women) with a mean age of 60·6 (10·4) years. The mean duration of diabetes was 12·4 years (range 3·9–20·9) and HbA1c concentrations ranged from 6·39% to 10·47% (mean 8·4% SD 2·0). The prevalence of CKD was 24% (95% CI 19–28). Among these, 76 (20%) had stage 3, ten (3%) had stage 4, and five (1%) had stage 5 CKD. In multivariate logistic regression, CKD was significantly associated with hypertension (adjusted odds ratio 5·7, 95% CI 2·2–15·2·2, p=0·0052), smoking (2·3, 1·3–4·2, p=0·0134), and age 60 years or older (3·2, 1·8–5·9, p<0·0001). InterpretationCKD was common among adults with diabetes attending PHC centres in this study. Screening of patients with diabetes to detect CKD at earlier stages and implementation of more aggressive treatment modalities for diabetes as well as other important risk factors, especially hypertension and smoking are recommended. FundingNone.