Abstract
In this study we conducted a cross sectional study to comprehensively evaluated the risk factors of chronic kidney disease (CKD) in a large sample of Chinese adults under primary care for type 2 diabetes mellitus (T2DM). We investigated the risk factors associated with the prevalence of CKD in adults with T2DM, who were enrolled in the Risk Factor Assessment and Management Programme for Patients with Diabetes Mellitus (RAMP-DM) of Hong Kong from July 2014 to June 2017. We collected the individual data of 31,574 subjects, with mean age of 63.0 (±10.8) years and mean DM duration of 7.4 (±6.4) years. Of them 9,386 (29.7%) had CKD and 7,452 (23.6%) had micro- or macro-albuminuria. After adjustment for multiple demographic and lifestyle confounders, we identified several modifiable risk factors associated with higher rate of CKD: obesity (OR = 1.54), current smoking (OR = 1.33), higher systolic blood pressure (OR = 1.01), dyslipidemia (OR = 1.32 and 0.61 for triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)), hyperglycemia (OR = 1.11 for HbA1c), diabetic retinopathy (OR = 1.36 and 2.60 for non-sight and sight threatening retinopathy), and stroke (OR = 1.43). The risk factors of lower dialytic blood pressure and coronary heart disease were identified only in men, whereas peripheral arterial disease only in women. In conclusion, several modifiable and gender specific risk factors were significantly associated with higher prevalence of CKD in Chinese adults with T2DM. The high-risk populations identified in this study shall receive regular screening for renal functions to achieve better patient management in primary care settings.
Highlights
In this study we conducted a cross sectional study to comprehensively evaluated the risk factors of chronic kidney disease (CKD) in a large sample of Chinese adults under primary care for type 2 diabetes mellitus (T2DM)
We investigated the risk factors associated with the prevalence of CKD in adults with T2DM, who were enrolled in the Risk Factor Assessment and Management Programme for Patients with Diabetes Mellitus (RAMP-DM) of Hong Kong from July 2014 to June 2017
The prevalence of CKD was 29.7% (9386/31574) at their first RAMP-DM assessment (Supplementary Table S1). 3,650 (11.6%) patients with T2DM were classified as the estimated glomerular filtration rate (eGFR) stages of G3a through G5, 7,452 (23.6%) as the urine albumin-to-creatinine ratio (UACR) stages of A2 through A3, and three (
Summary
In this study we conducted a cross sectional study to comprehensively evaluated the risk factors of chronic kidney disease (CKD) in a large sample of Chinese adults under primary care for type 2 diabetes mellitus (T2DM). In Hong Kong, the Risk Factor Assessment and Management Programme for Patients with Diabetes Mellitus (RAMP-DM) was implemented in the General Outpatients Clinics (GOPC) managed by the Hospital Authority (HA) since 2009, to conduct a comprehensive risk assessment and screening for diabetic complications in the primary care setting. Another objective of RAMP-DM was to educate DM patients by involving multi-disciplinary healthcare professionals including doctors, nurses and optometrists. The literature on the risk factors of CKD is less for T2DM than for type 1, and 99% of patients registered to RAMP-DM were diagnosed with T2DM; type 1 and gestational DM were excluded in this study
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