Association between microvascular complications and chronic kidney disease stages in type 2 diabetic patients

Authors

  • Rekha Vankwani Department of Medicine, Liaquat University and Medical Health Sciences, Jamshoro, Sindh, Pakistan
  • Mukesh Kumar Department of Nephrology, Liaquat University and Medical Health Sciences, Jamshoro, Sindh, Pakistan
  • Pooran Mal Department of Nephrology, Liaquat University and Medical Health Sciences, Jamshoro, Sindh, Pakistan
  • Sunil Gurbukshani Department of Nephrology, Liaquat University and Medical Health Sciences, Jamshoro, Sindh, Pakistan

DOI:

https://doi.org/10.53685/jshmdc.v5i2.278

Keywords:

Diabetes mellitus, Estimated glomerular filtration rate, Chronic kidney disease, Microvascular complications

Abstract

Background: Rapid urbanization and lifestyle changes have led to a surge in type 2 diabetes mellitus (T2DM) rates and its microvascular complications.

Objective: : To assess the association between microvascular complications and the stages of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus and to compare HbA1c levels across the different stages of CKD.

Methods: It was a cross sectional descriptive study conducted from 27th October 2022 to 26th April 2023 at outpatient Department of Nephrology, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan. Data was collected after approval from the Ethical Research Committee (LUMHS/REC/-243). Informed consent was obtained from 136 patients, males and females, 45 to 65 years of age, type 2 diabetics (for more than 10 years) with diagnosed CKD. The modification of diet in renal disease (MDRD) formula was used to estimate eGFR for chronic kidney disease staging. Diabetic retinopathy was diagnosed using fundoscopic examination and diabetic neuropathy was confirmed by symptoms and positive signs on examination. Data analysis was performed using SPSS version 22. A p-value of ≤ 0.05 was deemed statistically significant.

Results: Out of 136 patients, 75 (55.15%) were males and 61 (44.85%) were females. Mean age, eGFR, HbA1c, and duration of diabetes were 53.27 ±6.39 years, 54.55±27.26 mL/min/1.73 m², 9.02±1.67% and 14.06±4.05 years. The analysis showed that 8.1%, 40.4%, 22.05%, 22.05%, and 7.4% of patients were in CKD stages 1, 2, 3, 4, and 5, respectively. There was a significant association between diabetic microvascular complications, retinopathy and neuropathy, and the stages of CKD (p<0.05).

Conclusion: There is an association between microvascular complications i.e. neuropathy and retinopathy and the stages of CKD in type 2 diabetic patients. Additionally, HbA1c levels varied across CKD stages, highlighting the relationship between glycemic control and kidney function.

References

Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Ann Med Surg. 2022; 79:103901. doi: 10.1016/j.amsu.2022.103901 DOI: https://doi.org/10.1016/j.amsu.2022.103901

Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183: 109119. doi: 10.1016/j.diabres.2021.109119 DOI: https://doi.org/10.1016/j.diabres.2021.109119

Bhutta ZA, Ul Haq Z, Basit A. Diabetes in Pakistan: Addressing the crisis. Lancet Diabetes Endocrinol. 2022; 10(5): 309–310. doi: 10.1016/S2213-8587(22)00102-4 DOI: https://doi.org/10.1016/S2213-8587(22)00102-4

Hussein M, Menasri S. Prevalence of microvascular complications in type 2 diabetics attending a primary healthcare centre in Sudan. Dubai Diabetes Endocrinol J. 2019; 25(3-4): 127–133. doi: 10.1159/000500914 DOI: https://doi.org/10.1159/000500914

Babaliche P, Nadpara RA, Maldar A. Association between estimated glomerular filtration rate and microvascular complications in type II diabetes mellitus patients: A 1-year cross-sectional study. J Natl Med Assoc. 2019; 111(1): 83–7. doi: 10.1016/j.jnma.2018.06.003 DOI: https://doi.org/10.1016/j.jnma.2018.06.003

Samsu N. Diabetic nephropathy: Challenges in pathogenesis, diagnosis, and treatment. Biomed Res Int. 2021; 2021(1): 1497449. doi: 10.1155/2021/1497449 DOI: https://doi.org/10.1155/2021/1497449

De Boer IH, Khunti K, Sadusky T, Tuttle KR, Neumiller JJ, Rhee CM, et al. Diabetes management in chronic kidney disease: A consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022;45(12): 3075–3090. doi: 10.2337/dci22-0027 DOI: https://doi.org/10.2337/dci22-0027

Kim HJ, Kim SS, Song SH. Glomerular filtration rate as a kidney outcome of diabetic kidney disease: a focus on new antidiabetic drugs. Korean J Intern Med. 2022; 37(3): 502–519. doi: 10.3904/kjim.2021.515 DOI: https://doi.org/10.3904/kjim.2021.515

An L, Yu Q, Chen L, Tang H, Liu Y, Yuan Q, et al. The association between the decline of eGFR and a reduction of hemoglobin A1c in type 2 diabetic patients. Front Endocrinol.2021;12:723720. doi: 10.3389/fendo.2021.723720 DOI: https://doi.org/10.3389/fendo.2021.723720

Sartore G, Ragazzi E, Caprino R, Lapolla A. Long-term HbA1c variability and macro-/micro-vascular complications in type 2 diabetes mellitus: A meta-analysis update. Acta Diabetol. 2023; 60(6):721–738. doi: 10.1007/s00592-023-02037-8 DOI: https://doi.org/10.1007/s00592-023-02037-8

Wu J, Geng J, Liu L, Teng W, Liu L, Chen L. The relationship between estimated glomerular filtration rate and diabetic retinopathy. J Ophthalmol. 2015; 2015:326209. doi: 10.1155/2015/326209 DOI: https://doi.org/10.1155/2015/326209

Wang W, Ji Q, Ran X, Li C, Kuang H, Yu X, et al. Prevalence and risk factors of diabetic peripheral neuropathy: A population-based cross-sectional study in China. Diabetes Metab Res Rev. 2023; 39(8): e3702. doi: 10.1002/dmrr.3702 DOI: https://doi.org/10.1002/dmrr.3702

Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int.2024; 105(4):S117-314. doi: 10.1016/j.kint.2023.10.018. DOI: https://doi.org/10.1016/j.kint.2023.10.018

Kong AP, So WY, Szeto CC, Chan NN, Luk A, Ma RC, et al. Assessment of glomerular filtration rate in addition to albuminuria is important in managing type II diabetes. Kidney Int. 2006; 69(2): 383–387. doi: 10.1038/sj.ki.5000061 DOI: https://doi.org/10.1038/sj.ki.5000061

Jelinek HF, Osman WM, Khandoker AH, Khalaf K, Lee S, Almahmeed W, et al. Clinical profiles, comorbidities and complications of type 2 diabetes mellitus in patients from United Arab Emirates. BMJ Open Diabetes Res Care. 2017; 5(1): e000427. doi: 10.1136/bmjdrc-2017-000427 DOI: https://doi.org/10.1136/bmjdrc-2017-000427

Takenouchi A, Tsuboi A, Terazawa-Watanabe M, Kurata M, Fukuo K, Kazumi T. Direct association of visit-to- visit HbA1c variation with annual decline in estimated glomerular filtration rate in patients with type 2 diabetes. J Diabetes Metab Disord. 2015; 14(1). doi: 10.1186/s40200-015-0201-y DOI: https://doi.org/10.1186/s40200-015-0201-y

Kuo IC, Lin HYH, Niu SW, Hwang DY, Lee JJ, Tsai JC, et al. Glycated hemoglobin and outcomes in patients with advanced diabetic chronic kidney disease. Sci Rep. 2016; 6(1): 20028. doi: 10.1038/srep20028. DOI: https://doi.org/10.1038/srep20028

Hong J, Surapaneni A, Daya N, Selvin E, Coresh J, Grams ME, et al. Retinopathy and risk of kidney disease in persons with diabetes. Kidney Med. 2021; 3(5): 808-815. doi: 10.1016/j.xkme.2021.04.018 DOI: https://doi.org/10.1016/j.xkme.2021.04.018

Grunwald JE, Alexander J, Ying GS, Maguire M, Daniel E, Whittock-Martin R, et al. Retinopathy and chronic kidney disease in the Chronic Renal Insufficiency Cohort (CRIC) study. Arch Ophthalmol. 2012; 130(9): 1136. doi:10.1001/archophthalmol.2012.1800 DOI: https://doi.org/10.1001/archophthalmol.2012.1800

Wada R, Yagihashi S. Role of advanced glycation end products and their receptors in development of diabetic neuropathy. Ann N Y Acad Sci. 2005; 1043: 598–604. doi: 10.1196/annals.1338.067 DOI: https://doi.org/10.1196/annals.1338.067

Kajitani N, Shikata K, Nakamura A, Nakatou T, Hiramatsu M, Makino H. Microinflammation is a common risk factor for progression of nephropathy and atherosclerosis in Japanese patients with type 2 diabetes. Diabetes Res Clin Pract.2010;88(2):171–176. doi: 10.1016/j.diabres.2010.01.012 DOI: https://doi.org/10.1016/j.diabres.2010.01.012

Zhong M, Yang YR, Zhang YZ, Yan SJ. Change in urine albumin-to-creatinine ratio and risk of diabetic peripheral neuropathy in type 2 diabetes: A retrospective cohort study. Diabetes Metab Syndr Obes. 2021; 14: 1763–1772. doi: 10.2147/DMSO.S303096 DOI: https://doi.org/10.2147/DMSO.S303096

Van Buren PN, Toto R. Hypertension in Diabetic Nephropathy: Epidemiology, Mechanisms, and Management. Adv Chronic Kidney Dis. 2011; 18(1): 28–41. doi: 10.1053/j.ackd.2010.10.003 DOI: https://doi.org/10.1053/j.ackd.2010.10.003

Weiner DE, Tighiouart H, Elsayed EF, Griffith JL, Salem DN, Levey AS, et al. The Framingham predictive instrument in chronic kidney disease. J Am Coll Cardiol. 2007; 50(3) 217–224.doi: 10.1016/j.jacc.2007.03.037 DOI: https://doi.org/10.1016/j.jacc.2007.03.037

Choi HS, Han KD, Oh TR, Kim CS, Bae EH, Ma SK, et al. Smoking and risk of incident end-stage kidney disease in general population: A nationwide population-based cohort study from Korea. Sci Rep. 2019; 9(1). doi: 10.1038/s41598- 019-56113-7 DOI: https://doi.org/10.1038/s41598-019-56113-7

Downloads

Published

12/31/2024

How to Cite

[1]
Vankwani, R., Kumar, M., Mal, P. and Gurbukshani, S. 2024. Association between microvascular complications and chronic kidney disease stages in type 2 diabetic patients. Journal of Shalamar Medical & Dental College . 5, 2 (Dec. 2024), 71–76. DOI:https://doi.org/10.53685/jshmdc.v5i2.278.

Issue

Section

Original Articles