Prevalence and predictors of diabetic kidney disease: cross-sectional study in primary care
DOI:
https://doi.org/10.32385/rpmgf.v41i5.14156Palavras-chave:
Diabetic nephropathies, Prevalence, Risk factors, Primary health careResumo
Background: Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease. Primary healthcare is essential for early diagnosis and management.
Aim: To assess the prevalence and diagnostic accuracy of DKD. Additionally, to identify potential risk factors for DKD and evaluate the prescription of nephroprotective medications.
Design and setting: Cross-sectional study on a random sample of 387 patients with type 2 diabetes in a primary care center in northern Portugal.
Method: Demographic and laboratory data of patients and evidence of RASi and/or SGLT2i prescription were collected. DKD diagnosis was based on KDIGO 2012 guidelines. ICPC-2 codes U-99 and U-88 were considered adequate to identify coded DKD. Multivariable logistic regression was used to investigate associations between DKD and potential risk factors such as age, sex, BMI, hypertension, dyslipidemia, smoking, and diabetes duration, control, and its macrovascular or microvascular complications.
Results: There were 338 patients included. 58% were men, with a mean (±std) age of 71.4 (±10.2) years. DKD prevalence was 42,6% [95%CI, 37.4-48.0%] with only 9.5% properly coded. Most patients were in stages G2 (33.3%), G3a (30.6%), and G3b (14.6%), and concerning albuminuria, stage A2 (68.8%). Among those with DKD, 77.1% [69.6-83.2%], 60.4% [52.3-68.0%], and 43.1% [35.3-51.2%] were medicated with RASi, SGLT2i, and both, respectively. Male sex (OR=1.89), advanced age (OR=1.08), higher BMI (OR=1.06), macrovascular DM complications (OR=1.90), and dyslipidemia (OR=4.95) were independent risk factors for DKD.
Conclusions: This study highlights the high prevalence and underdiagnosis of DKD, identifying areas for practice improvement.
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Referências
1. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl. 2022;12(1):7-11.
2. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022;102(5S):S1-S127.
3. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 11. Chronic kidney disease and risk management: standards of care in diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S191-S202.
4. Hoogeveen EK. The epidemiology of diabetic kidney disease. Kidney Dial. 2022;2(3):433-42.
5. Vinhas J, Gardete-Correia L, Boavida JM, Raposo JF, Mesquita A, Fona MC, et al. Prevalence of chronic kidney disease and associated risk factors, and risk of end-stage renal disease: data from the PREVADIAB study. Nephron Clin Pract. 2011;119(1):c35-40.
6. Vinhas J, Aires I, Batista C, Branco P, Brandão J, Nogueira R, et al. RENA study: cross-sectional study to evaluate CKD prevalence in Portugal. Nephron. 2020;144(10):479-87.
7. Thomas MC, Brownlee M, Susztak K, Sharma K, Jandeleit-Dahm KA, Zoungas S, et al. Diabetic kidney disease. Nat Rev Dis Primers. 2015;1:15018.
8. Santos-Araújo C, Mendonça L, Carvalho DS, Bernardo F, Pardal M, Couceiro J, et al. Twenty years of real-world data to estimate chronic kidney disease prevalence and staging in an unselected population. Clin Kidney J. 2022;16(1):111-24.
9. World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA). ICPC-2: International Classification of Primary Care. 2nd ed. Oxford University Press; 2003.
10. Chu CD, Chen MH, McCulloch CE, Powe NR, Estrella MM, Shlipak MG, et al. Patient awareness of CKD: a systematic review and meta-analysis of patient-oriented questions and study setting. Kidney Med. 2021;3(4):576-85.e1.
11. Guessous I, McClellan W, Vupputuri S, Wasse H. Low documentation of chronic kidney disease among high-risk patients in a managed care population: a retrospective cohort study. BMC Nephrol. 2009;10:25.
12. Phillips K, Hazlehurst JM, Sheppard C, Bellary S, Hanif W, Karamat MA, et al. Inequalities in the management of diabetic kidney disease in UK primary care: a cross-sectional analysis of a large primary care database. Diabet Med. 2024;41(1):e15153.
13. Tomonaga Y, Risch L, Szucs TD, Ambühl PM. The prevalence of chronic kidney disease in a primary care setting: a Swiss cross-sectional study. PLoS One. 2013;8(7):e67848.
14. Wu B, Bell K, Stanford A, Kern DM, Tunceli O, Vupputuri S, et al. Understanding CKD among patients with T2DM: prevalence, temporal trends, and treatment patterns-NHANES 2007-2012. BMJ Open Diabetes Res Care. 2016;4(1):e000154.
15. Bouça B, Bogalho A, Agapito A. Nefropatia diabética [Diabetic nephropathy]. Rev Port Diabetes. 2021;16(2):80-9. Portuguese
16. Joshi R, Subedi P, Yadav GK, Khadka S, Rijal T, Amgain K, et al. Prevalence and risk factors of chronic kidney disease among patients with type 2 diabetes mellitus at a tertiary care hospital in Nepal: a cross-sectional study. BMJ Open. 2023;13(2):e067238.
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Direitos de Autor (c) 2025 Revista Portuguesa de Medicina Geral e Familiar
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