The prevalence of chronic kidney disease and associated factors among adult patients with type 2 Diabetes Mellitus who attend the diabetes centre in Gaborone, Botswana
Thesis (MFamMed)--Stellenbosch University, 2017.
ENGLISH SUMMARY : Background: Chronic Kidney Disease (CKD) is associated with increased cardiovascular morbimortality and overall mortality in patients with diabetes. Early detection and prevention of disease progression is therefore pertinent. Presently in Botswana there is no current published research on the prevalence of CKD in this high risk population and this has led to limited opportunities for early detection and availability of Renal Replacement Therapy (RRT). Aim and Objectives: We conducted this study to determine the prevalence of CKD and associated factors in adult patients with type 2 Diabetes Mellitus, and evaluate the management of those with CKD according to established guidelines. Stellenbosch University https://scholar.sun.ac.za Methods: This cross sectional study consecutively sampled 408 adult patients with type 2 Diabetes Mellitus who attended the Diabetes Centre in Gaborone, Botswana. The estimated glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR) were used to define renal function. CKD stages were defined according to the National Kidney Foundation (NKF) classification. Variables studied; socio-demographic and clinical parameters, blood and glycaemic control, pharmacological treatments and established complications of diabetes. Results: The prevalence of CKD was 63.5% (n=259) (95% CI: 58.7% to 68%). Overall albuminuria was observed in 62.59% (n= 255) of the participants. The frequency of the different stages of CKD in this group was: CKD 1 (53.3%, n=138), CKD 2 (29.7%, n=77); CKD 3 (13.9%, n=36); CKD 4 (2.3%, n=6) and CKD 5 (0.77 %, n=2). Associated sociodemographic and clinical risk factors: education level, duration of diabetes, BMI, poor glycaemic control and the presence of retinopathy. A folder audit on the management of CKD looked at seven quality outcomes; 1) glycaemic control, 2) blood pressure control, 3) the use of ACEI/ARB in blood pressure control, 4) the use of ACEI/ARB in the presence of microalbuminuria, 5) the use of Statin in elevated LDL levels, 6) protein restriction and 7) target BMI. There was poor target glycaemic and blood pressure control, both of which were not met at 38.2 % (n=99) and 20.9% (n=54) respectively. ACEI/ARB was used in 52.5% (n=136) of patients with hypertension and only 14.0 % (n=36) of those with normal blood pressure and microalbuminuria. Only 40.9% (n=106) of patients with elevated LDL levels were on Statin treatment. Target BMI was achieved in 19.3 % (n= 50) of the patients and protein restriction in only 8.1% (n=21). Conclusion: The prevalence of CKD is notably high, a large proportion of of which is earlier stages. Management of CKD was generally poor owing to poor screening measures. Periodic screening for albuminuria and eGFR is therefore essential in order to trigger stage appropriate monitoring and treatment.
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