Persistent Albuminuria in Patients Newly Diagnosed with Type 2 Diabetes Mellitus at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Persistent albuminuria is a marker of early diabetic nephropathy and increased cardiovascular morbidity and mortality. Therefore, there is need for screening for persistent albuminuria to prevent these complications. While early intervention could retard the progression of nephropathy in patients with persistent albuminuria, screening is not routinely done especially in resource limited settings and even the prevalence of persistent albuminuria is not widely known. Objectives: To determine the prevalence and associated clinical characteristics of persistent albuminuria among patients newly diagnosed with type 2 diabetes mellitus at MTRH. Methods: A cross sectional study on patients newly diagnosed with type 2 DM was conducted at the diabetic and medical outpatients’ clinics of Moi Teaching & Referral Hospital (MTRH), western Kenya. All patients who met the inclusion criteria were enrolled by consecutive sampling until the desired sample size was obtained. Data was collected using a structured interviewer administered questionnaire. Blood samples for fasting lipid profile, fasting blood sugar, serum creatinine and HbA1c, as well as a random urine sample for Urine-Albumin-Creatinine-Ratio (UACR) were obtained. Those who had UACR above 30mg/24hr had a repeat test done 2-3 months apart. Data was entered into Microsoft access database and analyzed using STATA where descriptive statistics were summarized in tables and graphs. Results: A total of 205 patients were screened between January and December 2013, with 92 patients (58% female) being enrolled into the study. Mean age was 55±12.5 years, mean BMI was 26.9±4.9 Kg/m2 and median duration of illness was 9 (IQR 3-14) months. Nearly half of the patients, 44 (47.8%) were known hypertensive, while 4 (4.4%) reported previous stroke. Few patients, 8 (8.7%) were on statins and aspirin 6 (6.5%). At enrollment, hypertension was recorded among 26 (28.25%) with the majority, 24 (55.5%) being known hypertensive patients. A third of the patients, 30 (32.6%) were on either angiotensin converting enzyme inhibitors or angiotensin receptor blockers. The majority of patients, 66 (71.7%) were on oral hypoglycemic agents, 22 (23.9%) on insulin alone, 3 (3.3%) on both oral hypoglycemic agents and insulin, while 1 (1.1%) patient was on diet alone. Most patients had poor glycemic control with 16 (17.4%) patients achieving a target HbA1c of ≤7%. Dyslipidemia was prevalent among 88 (96%) patients, with majority 76 (82.6%) having low High Density Lipoprotein (HDL) and 57 (62%) had high Low Density Lipoprotein (LDL). At the initial screening, 27 (29.4%) of the patients had spot albuminuria and 17 (18.5%) had persistent albuminuria. Over 90% of patients had estimated Glomerular Filtration Rate (eGFR) of >60. There was a positive association between, high serum creatinine (P=0.029), low eGFR (P=0.016) and persistent albuminuria while no associations were found with other clinical characteristics. Conclusion: There is a high prevalence of persistent albuminuria in patients newly diagnosed with type 2 DM. Although known risk factors for albuminuria such as hyperglycemia, dyslipidemia and hypertension were prevalent, only a positive association between high serum creatinine, low eGFR and persistent albuminuria was found. Recommendation: Screening for persistent albuminuria, dyslipidemia and serum creatinine should be done at diagnosis of all patients with type 2 DM.