Prevalence of chronic kidney disease in diabetic adult out-patients in Tanzania.
BACKGROUND
The number of adults with diabetes mellitus is increasing worldwide, particularly in Asia and Africa. In sub-Saharan Africa, renal complications of diabetes may go unrecognized due to limited diagnostic resources. The prevalence of chronic kidney disease (CKD) among adult diabetics in sub-Saharan Africa has not been well described.


METHODS
This study was conducted at the diabetes mellitus clinic of Bugando Medical Centre in Mwanza, Tanzania. A total 369 consecutive adult diabetic patients were enrolled and interviewed. Each patient provided a urine sample for microalbuminuria and proteinuria and a blood sample for serum creatinine level. Estimated glomerular filtration rate (eGFR) was calculated using the Cockroft-Gault equation. CKD was staged according to the Kidney Disease Improving Global Outcomes system.


RESULTS
A total of 309 (83.7%) study participants had CKD; 295 (80.0%) had significant albuminuria and 91 (24.7%) had eGFR < 60 ml/min. None of these patients were aware of their renal disease, and only 5 (1.3%) had a diagnosis of diabetic nephropathy recorded in their file. Older age was significantly associated with CKD in this population [OR 1.03, p = 0.03, 95%CI (1.00-1.05)].


CONCLUSIONS
Chronic kidney disease is highly prevalent among adult diabetic outpatients attending our clinic in Tanzania, but is usually undiagnosed. Nearly ¼ of patients had an eGFR low enough to require dose adjustment of diabetic medications. More diagnostic resources are needed for CKD screening among adults in Tanzania in order to slow progression and prevent complications.
Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania. mjanmohd@gmail.com.
Mubarakali N
MN
Janmohamed
Samuel E
SE
Kalluvya
Andreas
A
Mueller
Rodrick
R
Kabangila
Luke R
LR
Smart
Jennifer A
JA
Downs
Robert N
RN
Peck
D000328:Adult; D017677:Age Distribution; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors; D017678:Sex Distribution; D013636:Tanzania / Q000453:epidemiology