Incidence of Diabetic Nephropathy and Its Predictors among Type 2 Diabetes Mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Abstract

Background: Although the rate of diabetic nephropathy which is the leading cause of end-stage renal disease (ESRD) continues to rise, there is limited information about the problem. This study aimed to assess the incidence and predictors of diabetic nephropathy among type 2 DM patients.

Methods: Institution-based retrospective follow-up study was conducted at UGCSH with 462 newly diagnosed type 2 DM patients from January 2001 to February 2016, and the data were collected by reviewing their records. The Schoenfeld residuals test was used to check proportional hazard assumption. The best model was selected by using Akaike information criteria (AIC). Hazard ratios (HR) with its respective 95% confidence interval were reported to show significance and strength of association.

Results: The incidence rate of diabetic nephropathy was 14 (95% CI 10.8-17.7) cases per 10,000 patient-month observation. In addition, 63 (13.6%) DM patients developed diabetic nephropathy. The median time to develop diabetic nephropathy was 94.9 months with interquartile range (IOR) of (64.1-127.4) months. Type 2 DM patients who had coronary heart disease (AHR = 2.69, 95% CI 1.42-5.13) and anemia (AHR = 1.94, 95% CI 0.97-3.87) were at higher hazard for developing diabetic nephropathy. Besides this, having a long duration (>10 years) (AHR = 0.24, 95% CI 0.11-0.56) and being female (AHR = 0.44, 95% CI 0.26-0.73) was found to be protective against diabetic nephropathy.

Conclusion: The incidence of diabetic nephropathy among type 2 diabetes patients remains a significant public health problem. Duration of diabetes >10 years and female sex reduced the risk of diabetic nephropathy. Coronary heart disease and anemia increased the risk of diabetic nephropathy among type 2 DM patients. In light of these findings, early screening for diabetes complication is needed, and health professionals should give targeted intervention for type 2 DM patients with coronary heart disease comorbidity and anemia.

Figure 1

The Nelson–Aalen estimated cumulative curve showing cumulative probability of diabetic nephropathy among type 2 DM patients in University of Gondar Comprehensive Specialized Hospital, January 2001–February 2016.

Figure 2

Cox–Snell residuals for Weibull PH models of newly diagnosed T2DM patients in University of Gondar Comprehensive Specialized Hospital, January 2001–February 2016.