Prevalence of chronic kidney disease using estimated glomerular filtration rate among diabetes patients attending a tertiary clinic in Botswana

Rwegerera, Godfrey Mutashambara and Molefe-Baikai, Onkabetse and Masaka, Anthony and Shimwela, Meshack and Rivera, Yordanka and Oyewo, Taibat and Godman, Brian and Massele, Amos and Habte, Dereje (2018) Prevalence of chronic kidney disease using estimated glomerular filtration rate among diabetes patients attending a tertiary clinic in Botswana. Hospital Practice, 46 (4). pp. 214-220. ISSN 2377-1003 (https://doi.org/10.1080/21548331.2018.1506674)

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Abstract

Background and aims: Diabetes mellitus (DM) is one of the most common contributors of chronic kidney disease (CKD). The epidemiology of CKD, a concern among patients with DM, has not been studied in Botswana. The aim of this study was to estimate its prevalence among these patients to provide future guidance to both government personnel and physicians. Methods: Observational cross-sectional study in a leading clinic in Botswana. Demographic and clinical data were obtained from patients through interviews and from their notes using a standard questionnaire. The study was conducted from July to October 2015. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet for Renal Disease equation. CKD was defined as an eGFR < 60 ml/min/1.73m2. Multivariable logistic regression analyses were performed to assess the associations between CKD and potential factors. Results: Mean age and duration of diabetes mellitus among study participants were of 54.67 years (range 21-92 years) and 5.0 years respectively. Over half, i.e. 213/370 (57.6%) and 232/370 (62.7%), had an average blood pressure greater than 140/90mmHg and poor glycemic control (HbA1c >7%) respectively. 31/370 patients (8.4%) had CKD. However, only 18/370 (4.9%) had a diagnosis of CKD documented in their charts. Age, level of education, and duration of diabetes were independently associated with CKD. Conclusion: The prevalence of CKD by estimated eGFR was low compared to most previous studies. However, half of patients with CKD are not documented resulting in potential prescription errors and drug toxicity. A substantial number of patients had uncontrolled hypertension and poor glycemic control. Older age, low level of education and longer duration of DM were associated with CKD. There is a need to carry out prospective studies to determine the association and role of glycemic and blood pressure control in CKD causation among patients with DM in Botswana.

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