DOI: http://dx.doi.org/10.18203/2349-3933.ijam20193684

Study on prevalence of nephropathy in type 2 diabetes mellitus patients and associated factors

Nakkina Bhavani Prasad, G. Muralidhar

Abstract


Background: Diabetic nephropathy (DN) is the leading cause of end-stage renal disease and the care of patients with diabetes and DN contributes significantly to health care costs. The objective of this present study was to determine prevalence of nephropathy in type2 diabetes and associated factor.

Method: The present cross sectional study was conducted on type 2 diabetic subjects who attended the outpatient and inpatient wards of medicine department in GSL General Hospital from November 2015 to April 2017. Protocol approval was taken from institutional ethical committee and Informed consent from the study subjects was taken.

Result: In this study the overall prevalence of nephropathy in type 2 DM was 44.7% (67 cases). The prevalence of nephropathy was similar in both males (44.3%) and Females (45.1%). and significant association was not found between gender and nephropathy. On apply of chi-square test, association was not found to be statistically significant for Sex (p=0.9), and ECG (p=0.07), whereas association was found to be statistically significant for HbA1C (p=0.04), Dyslipidemia (p=0.006), and USG (p=0.001).

Conclusion: There is significant evidence to support the conclusion that microalbuminuria or proteinuria in patients with diabetes is a potential risk factor not only for kidney function impairment but also a marker for high risk of cardiovascular complications.

 


Keywords


Electrocardiogram, Nephropathy, Type 2 diabetes mellitus, Ultrasonography

Full Text:

PDF

References


International Diabetes Federation. IDF Diabetic Atlas 7th ed. http://www.idf.org/idf-diabetes-atlasseventh-edition. Accessed 30 Aug 2016.

Gilbert RE, Connelly K, Kelly DJ, Pollock CA, Krum H. Heart failure and nephropathy: catastrophic and interrelated complications of diabetes. Clin J Am Society of Nephrol. 2006 Mar 1;1(2):193-208.

Krum H, Gilbert RE. Demographics and concomitant disorders in heart failure. The Lancet. 2003 Jul 12;362(9378):147-58.

He Z. Diagnosis and treatment of diabetic nephropathy in type 1 and type 2 diabetes patients. J Mol Biomark Diagn. 2016;7(295):2.

Pálsson R, Patel UD. Cardiovascular Complications of Diabetic Kidney Disease Adv Chronic Kidney Dis. 2014 May; 21(3):273-80.

WHO study group Diabetes Mellitus, 2006. Available at www.who.int/diabetes/publications/en/. Accessed 15 Oct 2015.

Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Chair Recommendations for evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and European association of cardiovascular imaging J Am Soc Echocardiogr. 2016;29(4):277-314

Unnikrishnan R, Rema M, Pradeepa R, Deepa M, Shanthirani CS, Deepa R, et al. Prevalence and risk factors of diabetic nephropathy in an urban South Indian population: the Chennai Urban Rural Epidemiology Study. Diabetes care. 2007 Aug 1;30(8):2019-24.

Shaw PK, Baboe F, van Es LA, van der Vijver JC, van de Ree MA, de Jonge N, et.al. South-Asian type 2 diabetic patients have higher incidence and faster progression of renal disease compared with Dutch-European diabetic patients. Diabetes Care. 2006 Jun 1;29(6):1383-5.

Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR. Risk factors for renal dysfunction in type 2 diabetes: UK Prospective Diabetes Study 74. Diabetes. 2006 Jun 1;55(6):1832-9.

Wirta OR, Pasternack AI, Oksa HH, Mustonen JT, Koivula TA, Helin HJ, et. al. Occurrence of late specific complications in type II (non-insulin-dependent) diabetes mellitus. J Diabetes Complications.1995;9:177-85.

Collins VR, Dowse GK, Plehwe WE, Imo TT, Toelupe PM, Taylor HR et. al. High prevalence of diabetic retinopathy and nephropathy in Polynesians of Western Samoa. Diabetes Care.1995;18:1140-9.

Krairittichai U, Potisat S, Jongsareejit A, Sattaputh C. Prevalence and risk factors of diabetic nephropathy among Thai patients with type 2 diabetes mellitus. Journal of the Medical Association of Thailand= Chotmaihet thangphaet. 2011 Mar;94:S1-5.

Kumar S, Aneja GK, Trivedi A, Atam V, Shankhwar SN, Panwar A, et al. Correlation of Diabetic Nephropathy and HbA1C in Newly Diagnosed Type 2 Diabetic Patients of Western UP. International Journal of Scientific and Research Publications. 2014;4(12):1-4.

Debbarma B, Debbarma R, Pegu AK. Significance of Microalbuminuria in Newly Diagnosed type 2 Diabetes Mellitus IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)2015;14(8):40-7.

Watanabe Y, Fujii H, Aoki K, Kanazawa Y, Miyakawa T. A cross-sectional survey of chronic kidney disease and diabetic kidney disease in Japanese type 2 diabetic patients at four urban diabetes clinics. Internal Medicine. 2009;48(6):411-4.

Muthuvel E, Chander V, Balu S. Study of incidence of microalbuminuria among first diagnosed diabetic patients and its correlation with body mass index and coexisting hypertension in a tertiary care hospital. Annals of Pathology and Laboratory Medicine. 2017;4(2):A203-7.

Reddy YJ, Banoth M, Reddy YG, Eslavath R. A Study on Correlation of Diabetic Retinopathy In Relation To Diabetic Nephropathy in Type II DM Patients. Journal of Evidence based Medicine and Healthcare. 2015;2(33):4909-17.

Gall MA, Hougaard P, Borch-Johnsen K, Parving HH: Risk factors for development of incipient and overt Diabetic Nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study. BMJ. 1997;314: 783-8.

Naji Younes. Comparison of Urinary Albumin-Creatinine Ratio and Albumin Excretion Rate in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Clin J Am Soc Nephrol. 2010;5(7):1235-42.

Fisher H, Hsu CY, Vittinghoff E, Lin F, Bansal N. Comparison of associations of urine protein-creatinine ratio versus albumin-creatinine ratio with complications of CKD: a cross-sectional analysis. Am J Kidney Diseases. 2013 Dec 1;62(6):1102-8.

Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro AF, Feldman HI, et. al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12.

Shivashankara VU, Shivalli S, Pai BS, Acharya KD, Gopalakrishnan R, Srikanth V, et. al. A comparative study of sonographic grading of renal parenchymal changes and estimated glomerular filtration rate (eGFR) using modified diet in renal disease formula. Journal of clinical and diagnostic research: JCDR. 2016 Feb;10(2):TC09.

Fiorini F, Barozzi L. The role of ultrasonography in the study of medical nephropathy. Journal of ultrasound. 2007 Dec 1;10(4):161-7.

Fiegler W, Cromme R, Szekessy T, Kampf D. Ultrasound in Diffuse Renal Parenchymal Disease. 1981;135(6):645-8.

Gareeballah A, Gameraddin M, Mustafa H, Alshabi S, Alagab FE, Tamboul J, Salih S. Sonographic findings in renal parenchymal diseases at Sudanese. Open J Radiol. 2015 Dec 4;5(04):243.

Derchi LE, Martinoli C, Saffioti S, Pontremoli R, De Micheli A, Bordone C. Ultrasonographic imaging and Doppler analysis of renal changes in non-insulin-dependent diabetes mellitus. Academic radiology. 1994 Oct 1;1(2):100-5.

Singh A, Gupta K, Chander R, Vira M. Sonographic grading of renal cortical echogenicity and raised serum creatinine in patients with chronic kidney disease. J Evolution Med Dent Sci. 2016 May 12;5:2279-86.

Nelaj E, Gjata M, Sadiku E, Tase M. Left ventricular hypertrophy and diabetic nephropathy; factors that influencing this relationship. In18th European Congress of Endocrinol. 2016 May 13 (Vol. 41). BioScientifica.

Bayauli MP, Lepira FB, Kayembe PK, M’Buyamba-Kabangu JR. Left ventricular hypertrophy and geometry in type 2 diabetes patients with chronic kidney disease. An echocardiographic study. Cardiovascular J Africa. 2012 Mar;23(2):73-7.

Wu N, Zhao W, Ye K, Li Y, He M, Lu B, Hu R. Albuminuria is associated with left ventricular hypertrophy in patients with early diabetic kidney disease. International J endocrinol. 2014.

Nielsen FS, Ali S, Rossing P, Bang LE, Svendsen TL, Gall MA, at al. Left ventricular hypertrophy in non‐insulin‐dependent diabetic patients with and without diabetic nephropathy. Diabetic medicine. 1997 Jul;14(7):538-46.

Thomas MC. Anemia in diabetes: marker or mediator of microvascular disease? Nat Clin Pract Nephrol. 2007;3:20-30.

Mohanram A, Zhang Z, Shahinfar S, Keane WF, Brenner BM, Toto RD. Anemia and end-stage renal disease in patients with type 2 diabetes and nephropathy, Kidney Int. 2004;66:1131-8.

Keane WF, Lyle PA. Recent advances in management of type 2 diabetes and nephropathy: lessons from the RENAAL study. Am J Kidney Dis. 2003;41:S22-5.

Jerums G, Macisaac R, Munzel T. Anemia and Diabetic Nephropathy, Chapter · January 2006 with 3 Reads. Publisher: The Humana Press Inc, Totowa, USA, 525-546.

Babazono T, Hanai K, Suzuki K, Kiuchi Y, Inoue A, Tanaka M, et al. Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria. Diabetologia. 2006;49(6):1387-93.