Chronic Kidney Disease and Associated Factors among Diabetic Patients at the Diabetic Clinic in a Police Hospital, Addis Ababa

Prevalence of nephropathy among patients with diabetes mellitus in Africa: a systematic review and meta-analysis

Background

Diabetic nephropathy (DN) is one of the most frequent microvascular consequences of diabetes, accounting for a significant portion of morbidity and mortality in diabetic patients in Africa. This study aims to report on the prevalence of nephropathy among patients with diabetes mellitus patients in Africa and the risk factors.

Methods

This systematic review was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, and the protocol was pre-registered in PROSPERO with the registration number CRD42024587467. The search was conducted across databases such as PubMed, Google Scholar, CINAHL and Scopus to retrieve studies published between January 2000 and August 2024. All statistical analyses were conducted using R software (version 4.4.2). The pooled prevalence of nephropathy in patients with diabetes was calculated with a 95% confidence interval (CI).

Results

Thirty-four (34) articles met the inclusion criteria. Only 28 studies were incorporated into the meta-analysis to determine the pooled prevalence of nephropathy among diabetes patients. The findings indicated a pooled prevalence of 21% (95%, CI: 16-28) of nephropathy among diabetes patients. Among type 1 and type 2 diabetes patients, the pooled prevalence of nephropathy is 46% (95%, CI: 18-77, I² = 98%) and 20% (95% CI: 14-27, I² = 98%), respectively. Weighted prevalence of 47%, 31%, 33% and 11% were reported in North Africa, Central Africa, South Africa and West Africa respectively. The result also showed that diabetes patients with hypertension are more than three times at risk of developing nephropathy compared to those without hypertension OR:3.46 (95% CI: 2.61-4.59).

Conclusion

The current study showed the prevalence of nephropathy with a significant association with hypertension among diabetic mellitus patients. Higher prevalence in North Africa is likely due to Western cultural impacts on dietary consumption.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024587467.

Prevalence and associated factors of chronic kidney disease among diabetes mellitus patients in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Chronic kidney disease (CKD) is a major public health concern worldwide, especially among people with diabetes mellitus (DM), which is the main cause of morbidity and mortality. In Ethiopia, the burden of CKD on DM patients is compounded by a variety of socioeconomic and healthcare-related issues. Despite the increased risk of developing CKD in DM patients, comprehensive studies on the prevalence and associated factors of CKD in this population are rare. To address this gap, this study aimed to estimate the pooled prevalence and associated factors of CKD among DM patients in Ethiopia.

METHODS

This systematic review and meta-analysis was carried out through an investigation of published studies in Ethiopia. A systematic literature search was performed using electronic databases such as PubMed, EMBASE, Scopus, and Google Scholar. A random-effects model was used to estimate the pooled prevalence of CKD and the odds ratio (OR) with a 95% confidence interval. The I² statistic was used to measure heterogeneity among the included studies, with a p-value < 0.05 indicating statistical significance. Publication bias was evaluated via a funnel plot and Egger's test, and subgroup, sensitivity, and meta-regression analyses were also performed.

RESULTS

Out of the 19 included studies, the estimated pooled prevalence of CKD among DM patients in Ethiopia was 18% (95% CI 14.0, 22.0). In addition, age ≥ 60 years (OR = 3.07, 95% CI: 2.44, 3.87), rural residence (OR = 1.40, 95% CI: 1.01, 1.95), duration of DM > 5 years (OR = 2.47, 95% CI: 1.62, 3.77), proteinuria (OR = 3.30, 95% CI: 2.23, 4.88), HDL-C level < 40 mg/dL (OR = 3.08, 95% CI: 2.28, 4.16), and family history of CKD (OR = 2.58, 95% CI: 1.62, 4.09) were factors significantly associated with the prevalence of CKD among DM patients.

CONCLUSION

The prevalence of CKD in Ethiopia was high, affecting nearly two in five individuals with diabetes. In addition, factors such as older age, rural residence, longer DM duration, positive proteinuria, lower HDL-C levels, and a family history of CKD were significantly associated with CKD prevalence. Therefore, targeted public health interventions, such as screening, education, and awareness programs, are highly recommended to mitigate this problem.

SYSTEMATIC REVIEW REGISTRATIONS

PROSPERO (2024: CRD42024576958).

Predictors of functional status and disability among patients living with chronic kidney diseases at St Paul's hospital millennium medical college, Ethiopia: findings from a cross-sectional study

BACKGROUND

The rise in risk factors like obesity, hypertension, and diabetes mellitus has partly led to the increase in the number of patients affected by chronic kidney disease, affecting an estimated 843 million people, which is nearly 10% of the general population worldwide in 2017. Patients with CKD have an increased risk of functional difficulties and disability. This study aimed to assess the level of functional status and disability and its associated factors among patients with chronic kidney attending Saint Paul Hospital, Millennium Medical College, Addis Ababa, Ethiopia.

METHODS

An institution-based cross-sectional study was conducted with 302 enrolled study participants through systematic random sampling techniques. Face-to-face interviews and chart reviews were used to collect data using a semi-structured questionnaire adapted from works of literature. The Health Assessment Questionnaire Disability Index (HAQ-DI) was used to assess the functional status and disability of the participants. Data was entered into EPI info version 7 and exported to SPSS version 23 for analysis. Bivariate logistic regression analysis was employed with a p-value less than 0.25. Finally, those variables with a p-value less than 0.05 in multivariate analysis were taken as statistically significant.

RESULTS

A total of 219 (72.5%) CKD patients had moderate to severe functional limitation and disability (HAQ-Di > 0.5-3). Age > 50 years [AOR = 1.65; 95% CI (1.23, 3.15)], being at stage 2 and 3 CKD [AOR = 4.05; 95% CI (1.82, 9.21), being at stage 4 and 5 CKD [AOR = 2.47; 95% CI (1.87, 4.72)], and having MSK manifestations [AOR = 2.97; 95% CI (1.61, 5.55)] were significantly associated with functional status and disability.

CONCLUSION

The findings of this study suggest that CKD-associated functional disabilities are common. The advanced stage of CKD, higher age, and presence of musculoskeletal manifestations appear to be important variables predicting self-reported functional status. Healthcare professionals treating CKD shall be vigilant about the CKD-associated disability, the modifiable predictors, and interventions to limit the CKD-related disability.

Out of sight: chronic kidney diseases among diabetic patients attending care and follow up. Findings from pastoralist health facilities of Southern Ethiopia

Background

In Ethiopia, the prevalence of chronic kidney disease (CKD) among the adult population ranges to 19.1%. The disease's impact has increased in low-resource settings due to a lack of knowledge about the condition and its risk factors. Diabetes is one of the numerous causes of CKD. Despite this, little was known in Ethiopia, particularly in the study area. This study aimed to identify the determinants of CKD among diabetic patients enrolled in care and follow up at pastoralist health facility of Jinka General Hospital (JGH), Southern Ethiopia, 2023.

Methods

An institutional-based cross-sectional study design was conducted among 626 diabetic patients recruited through a systematic random sampling. Data was collected using a structured interviewer-administered questionnaire and entered into Epi data version 7.2 and then exported to the Statistical Package for Social Sciences (SPSS) version 25 for further analysis. Bivariate and multivariate logistic regression analyses were conducted to find eligible variables for the later analysis. Variables with p < 0.25 at bivariate logistic regression were selected for multivariate logistic regression analysis. The variables with p < 0.05 at the multivariate analysis were taken as statically significant in the final model.

Results

The prevalence of CKD was 2.7% (95% CI: 1.12-6.01%). Place of residence (AOR: 4.84; 95% CI: 1.51-15.40), presence of hypertension (AOR: 5.69; 95% CI: 1.58-20.51) and family history of CKD (AOR: 6.20; 95% CI: 1.40-15.49) were factors associated with CKD among diabetes patients.

Conclusion

The prevalence found in this study was low when compared with the local studies. Provision of health education to diabetic patients on preventative measures such as physical exercise is cost-effective approach. Factors associated with CKD among diabetics can be significantly mitigated by strengthening the existing NCDs prevention packages in the study area particularly and in Ethiopia generally.