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. 2015 Jun;64(3):201-8.
doi: 10.7727/wimj.2014.084. Epub 2015 May 4.

Prevalence of Chronic Kidney Disease among Patients Attending a Specialist Diabetes Clinic in Jamaica

T S Ferguson  1 , M K Tulloch-Reid  2 , N O Younger-Coleman  2 , R A Wright-Pascoe  3 , M S Boyne  2 , A K Soyibo  3 , R J Wilks  2
Affiliations

Prevalence of Chronic Kidney Disease among Patients Attending a Specialist Diabetes Clinic in Jamaica

T S Ferguson et al. West Indian Med J. 2015 Jun.

Abstract
in English, Spanish

Objective: To estimate the prevalence of chronic kidney disease (CKD) among patients attending the University Hospital of the West Indies (UHWI) Diabetes Clinic and to determine the proportion of patients at high risk for adverse outcomes.

Methods: We conducted a cross-sectional study among patients attending the UHWI Diabetes Clinic between 2009 and 2010. Trained nurses administered a questionnaire, reviewed dockets, and performed urinalyses. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Albuminuria was assessed using urine test strips for protein and microalbumin. Chronic kidney disease was defined as an eGFR < 60 ml/min/1.73m2 or albuminuria ≥ 30 mg/g creatinine. Risk of adverse outcome (all-cause mortality, cardiovascular disease and kidney failure) was determined using the Kidney Disease: Improving Global Outcome (KDIGO) 2012 prognosis grid.

Results: Participants included 100 women and 32 men (mean age, 55.4 ± 12.9 years, mean duration of diabetes, 16.7 ± 11.7 years). Twenty-two per cent of participants had eGFR < 60 ml/min/1.73m2. Moderate albuminuria (30-300 mg/g) was present in 20.5% of participants and severe albuminuria (> 300 mg/g) in 62.1%. Overall prevalence of CKD was 86.3% (95%CI 80.4%, 92.2%). Based on KDIGO risk categories, 50.8% were at high risk and 17.4% at very high risk of adverse outcomes.

Conclusion: Most patients at the UHWI Diabetes Clinic had CKD and were at high or very high risk of adverse outcomes. Further studies to determine the burden of CKD in other clinical settings and to identify the best strategies for preventing adverse outcomes in developing countries need to be conducted.

Objetivo:: Estimar la prevalencia de enfermedad renal crónica (ERC) entre los pacientes que asisten a la Clínica de Diabetes del Hospital Universitario de West Indies (HUWI) y determinar la proporción de pacientes con alto riesgo de resultados adversos.

Métodos:: Se realizó un estudio transversal entre los pacientes que asisten a la Clínica de Diabetes del HUWI entre 2009 y 2010. Enfermeras entrenadas aplicaron una encuesta, revisaron los expedientes, y realizaron urinálisis. La tasa de filtración glomerular estimada (TFGe) se calculó usando la ecuación CKD-EPI, del grupo Chronic Kidney Disease Epidemiology Collaboration (Colaboración para la (Epidemiología de la Enfermedad Renal Crónica). La albuminuria se evaluó mediante las tiras reactivas de orina para la proteína y la microalbúmina. La enfermedad renal crónica se definió como una TFGe < 60 ml/min/1.73m2 o albuminuria ≥ 30 mg/g de creatinina. El riesgo de resultados adversos (mortalidad por todas las causas, enfermedad cardiovascular y fallo renal) se determinó usando el modelo de prognosis publicado por la organización Kidney Disease: Improving Global Outcome (KDIGO), en 2012.

Resultados:: Los participantes incluyeron 100 mujeres y 32 hombres (edad promedio 55.4 ± 12.9 años, duración promedio de la diabetes, 16.7 ± 11.7 años). Veintidós por ciento de los participantes tenían TFGe < 60 ml/min/1.73 m2. La albuminuria moderada (30 – 300 mg/g) estaba presente en el 20.5% de los participantes, y la albuminuria severa (> 300 mg/g) en el 62.1%. La prevalencia general de ERC fue 86.3% (95% IC 80.4%, 92.2%). Basado en las categorías de riesgo de KDIGO, el 50.8% se hallaban en alto riesgo, y 17.4% en muy alto riesgo de resultados adversos.

Conclusión:: Mayoría de los pacientes en la Clínica de Diabetes de HUWI tenían ECR y se hallaban en riesgo alto o muy alto de resultados adversos. Se necesita llevar a cabo estudios adicionales para determinar la carga de ECR en otros contextos clínicos, e identificar las mejores estrategias para prevenir resultados adversos en los países en desarrollo.

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Figures

Fig. 1
Fig. 1. Prevalence of chronic kidney disease in specific glomerular filtration rate (GFR) and albuminuria risk categories with colour-coded risk categories.
Colours indicate risk categories for adverse outcomes (death, cardiovascular disease or need for renal replacement therapy): green = low risk; yellow = moderately increased risk; orange = high risk; red = very high risk
Fig. 2
Fig. 2. Proportion of participants in the Kidney Disease: Improving Global Outcomes (KDIGO) prognostic risk groups.
See this image and copyright information in PMC

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