INCIDENCE AND PREDICTORS OF CHRONIC KIDNEY DISEASES AMONG DIABETES MELLITUS PATIENTS IN GOVERNMENTAL HOSPITALS OF HARARI REGION, EASTERN ETHIOPIA.

Abstract

Background: Chronic kidney disease (CKD) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Determining the incidence and predictors of developing CKD in diabetes patients is important to apply evidence-based interventions for a better outcome. However, this information is scarce in low-resource setting health institutions. Objectives: The study aimed to assess the incidence and predictors of CKD among patients diagnosed with Diabetes Mellitus (DM) at the Governmental Hospital of Harari region. Methods: A retrospective follow-up study was conducted among type 1 and type 2 DM patients diagnosed within the period of September 1, 2012, to August 30, 2022, and followed their treatment in governmental hospitals of the Harari region. A total of 520 patients were included in the study. Patient charts were selected randomly using excel generated random numbers and data were extracted from their medical records. The incidence of newly diagnosed CKD was calculated with 95% CI and compared by type of DM. Kaplan Meier failure curve and the log-rank test were done to compare the probability of developing CKD among baseline and follow-up characteristics of patients. Predictors of CKD were determined using the Gompertz regression model with the baseline cox model. Results: Overall, of 494 patients, 10.32% of them had developed CKD over the ten years follow-up period. The incidence rate was 2.16 cases per 100 person-years of observation with 95% CI of (1.64-2.84).The hazard of CKD was higher among DM patients older than 60 years (AHR: 3.09, 95% CI: 1.56, 6.14), longer than 5 years of stay with the DM (AHR: 3.53, 95% CI: 1.43, 8.71), among DM patients with HDL-C < 40 mg/dl (AHR: 3.84, 95% CI, 1.80- 8.18) and those with positive baseline proteinuria (AHR:3.77,95% CI: 1.43-8.71). Conclusion: We found that one-in-ten diabetic patients had developed CKD within ten years of the DM diagnosis. Advanced age, longer duration of diabetes, lower baseline HDL-C level and proteinuria had increased the hazards of developing CKD. We recommend a more targeted follow-up of elderly patients with advanced disease status at baseline for the optimal control of the DM that prevents its furthering to CKD.