Abstract
BackgroundThe number of adults with diabetes mellitus is increasing worldwide, particularly in Asia and Africa. In sub-Saharan Africa, renal complications of diabetes may go unrecognized due to limited diagnostic resources. The prevalence of chronic kidney disease (CKD) among adult diabetics in sub-Saharan Africa has not been well described.MethodsThis study was conducted at the diabetes mellitus clinic of Bugando Medical Centre in Mwanza, Tanzania. A total 369 consecutive adult diabetic patients were enrolled and interviewed. Each patient provided a urine sample for microalbuminuria and proteinuria and a blood sample for serum creatinine level. Estimated glomerular filtration rate (eGFR) was calculated using the Cockroft-Gault equation. CKD was staged according to the Kidney Disease Improving Global Outcomes system.ResultsA total of 309 (83.7%) study participants had CKD; 295 (80.0%) had significant albuminuria and 91 (24.7%) had eGFR < 60 ml/min. None of these patients were aware of their renal disease, and only 5 (1.3%) had a diagnosis of diabetic nephropathy recorded in their file. Older age was significantly associated with CKD in this population [OR 1.03, p = 0.03, 95%CI (1.00-1.05)].ConclusionsChronic kidney disease is highly prevalent among adult diabetic outpatients attending our clinic in Tanzania, but is usually undiagnosed. Nearly ¼ of patients had an eGFR low enough to require dose adjustment of diabetic medications. More diagnostic resources are needed for CKD screening among adults in Tanzania in order to slow progression and prevent complications.
Highlights
The number of adults with diabetes mellitus is increasing worldwide, in Asia and Africa
In Tanzania, the large majority of diabetic patient care is provided at referral and regional hospital clinics as these are the only facilities that have a reliable supply of the necessary equipment and drugs for diagnosis and management of diabetes mellitus
More than 80% of patients had chronic kidney disease (CKD) and nearly 25% had an Estimated glomerular filtration rate (eGFR)
Summary
The number of adults with diabetes mellitus is increasing worldwide, in Asia and Africa. In sub-Saharan Africa, renal complications of diabetes may go unrecognized due to limited diagnostic resources. The prevalence of chronic kidney disease (CKD) among adult diabetics in sub-Saharan Africa has not been well described. The World Health Organization (WHO) predicted that the number of people living with this disease would reach 221 million by 2010 and will further increase to 300 million by 2025 with the majority of new cases occurring in Asia and Africa [1,2]. In sub-Saharan Africa alone, the number of people with diabetes is projected to increase from 7 million in 2000 to 18 million in 2030, a regional increase of 161% [3]. Screening for CKD is not routinely performed in many diabetic clinics in sub-Saharan Africa due to limited diagnostic resources. Microalbumin testing is available in very few centers [4]
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