Prevalence and determinants of chronic kidney disease among patients with type 2 diabetes followed in a sub-Saharan resource-limited setting during COVID-19 pandemic (case of Dschang District Dospital)

Abstract

Background: Diabetes is a chronic metabolic condition associated with an increased risk of chronic kidney disease (CKD). However, coronavirus disease 2019 (COVID-19) was associated with a reduction in patient consultations and admissions. This study aimed to estimate the prevalence of CKD and its determinants among a sub-Saharan population of participants with diabetes during this pandemic. Methods: A cross-sectional study was conducted from March to July 2021 among adult participants with type 2 diabetes in the Dschang District Hospital (DDH). Sociodemographic, clinical and biological data were collected using a questionnaire. The glomerular filtration rate was estimated using the CKD-Epidemiology Collaboration (CKD-EPI) formula, while proteinuria was collected on the urinary spot. The presence of one or both markers was used to determine CKD. Bivariate analyses were performed to identify the factors associated with a significance level (P<0.05). Results: A total of 85 participants (38 men) were selected with a median age of 61 [49–69] years. Proteinuria was present in 37 (43.5%) of them. The reduced estimated glomerular filtration rate (eGFR) was found in 25 (29.4%) of the participants. CKD prevalence was 58.8% in the population study. The factors associated with eGFR reduction in bivariate analysis were hypertension (OR: 5.42; 95% CI: 1.92–15.3; P<0.001), consumption of nephrotoxic drugs (OR: 0.24; 95% CI: 0.09–0.67; P=0.003), diabetes duration less than 5 years (OR: 0.38; 95% CI: 0.15–1.02; P=0.029), diabetes duration equal or more than 10 years (OR: 3.14; 95% CI: 1.14–8.64; P=0.015), the presence of neuropathy (OR: 2.41; 95% CI: 0.83–8.52; P=0.048), and advanced age (OR: 4.14; 95% CI: 1.45–11.84; P=0.003). In multivariate analysis, only hypertension was associated with eGFR reduction. Retinopathy was the only factor associated (OR: 0.43; 95% CI: 0.16–1.15; P=0.048) with the presence of proteinuria. Only hypertension (OR: 3.2; 95% CI: 8.16–1.15; P=0.04) was associated with CKD. Conclusions: CKD is common at the DDH. Although the presence of proteinuria was associated with retinopathy and eGFR reduction with hypertension, only hypertension was a determinant for CKD among patients with T2D at the DDH. Appropriate diagnosis and management of hypertension is necessary.