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.