Incidence and predictors of chronic kidney disease in type-II diabetes mellitus patients attending at the Amhara region referral hospitals, Ethiopia: A follow-up study

PLOS ONE RESEARCH ARTICLE Incidence and predictors of chronic kidney disease in type-II diabetes mellitus patients attending at the Amhara region referral hospitals, Ethiopia: A follow-up study Medina Abdela Ahmed1, Yohannes Mulu Ferede ID1*, Wubet Worku Takele2 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 2 Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia * Abstract Background OPEN ACCESS Citation: Ahmed MA, Ferede YM, Takele WW (2022) Incidence and predictors of chronic kidney disease in type-II diabetes mellitus patients attending at the Amhara region referral hospitals, Ethiopia: A follow-up study. PLoS ONE 17(1): e0263138. https://doi.org/10.1371/journal. pone.0263138 Editor: Michele Provenzano, Magna Graecia University of Catanzaro: Universita degli Studi Magna Graecia di Catanzaro, ITALY Chronic kidney disease (CKD) is the severest form of kidney disease characterized by poor filtration. The magnitude of chronic kidney disease is trending upward in the last few years linked with the rapidly escalating cases of non-communicable chronic diseases, particularly diabetes mellitus. However, little is known about when this problem may occur, the incidence as well as predictors of chronic kidney disease among type-II diabetes mellitus patients. Thus, this study was conducted to determine the incidence, time to the occurrence, and predictors of chronic kidney disease in type-II diabetic patients attending the Amhara region referral hospitals, Ethiopia. Received: August 27, 2021 Methods Accepted: January 12, 2022 A retrospective follow-up study was conducted involving 415 participants with type-II diabetes mellitus that enrolled in the chronic follow-up from 2012 to 2017. Multivariable shared Frailty Weibull (Gamma) survival model was employed considering the hospitals as a clustering variable. Model fitness was checked by both the Akaike information criteria (AIC) and log-likelihood. Factors having a p-value of �0.2 in the bi-variable analysis were considered to enter the multivariable model. Variables that had a p-value of <0.05 with its corresponding 95% confidence level were deemed to be significant predictors of chronic kidney disease. Published: January 26, 2022 Copyright: © 2022 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: XXX All relevant data are within the manuscript and its Supporting information files. Funding: This study was funded by a grant from the University of Gondar (grant number UoG19R/ 2021) awarded to MAA. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Results The overall cumulative incidence of chronic kidney disease was 10.8% [95%; CI: 7.7– 14.0%] with a median occurrence time of 5 years. The annual incidence rate was 193/ 10,000 [95%; CI: 144.28–258.78]. Having cardiovascular disease/s [AHR = 3.82; 95%CI: 1.4470–10.1023] and hypercholesterolemia [AHR = 3.31; 95% CI: 1.3323–8.2703] were predictors of chronic kidney disease. PLOS ONE | https://doi.org/10.1371/journal.pone.0263138 January 26, 2022 1 / 14 PLOS ONE Competing interests: The authors have declared that no competing interests exist. Abbreviations: CKD, Chronic Kidney Diseases; AIC, Akakie Information Criteria; DM, Diabetes Mellitus; eGFR, estimated Glomerular Filtration Rate; HDL, High-Density Lipoprotein; HTN, Hypertension; LDL, Low-Density Lipoprotein; NCD, NonCommunicable Disease; SDG, Sustainable Development Goal; T2DM, Type 2 Diabetes Mellitus; TGL, Triglyceride; WHO, World Health Organization. Incidence and predictors of chronic kidney disease in type-II diabetes mellitus patients Conclusion One out of every ten diabetic patients experienced chronic kidney disease. The median time to develop chronic kidney disease was five years. Hypercholesterolemia and cardiovascular diseases have escalated the hazard of developing CKD. Thus, health promotion and education of diabetic patients to optimize cholesterol levels and prevent cardiovascular disease is recommended to limit the occurrence of this life-threatening disease. Introduction Diabetes mellitus (DM) is a metabolic disorder associated with either the failure of the pancreatic islet beta cells that produce insulin, or insulin resistant where the human body cannot uptake the available insulin effectively [1]. DM is alarmingly increasing and becoming one of the pressing public health problems among other non-communicable chronic diseases (NCD) globally [2]. The prevalence of DM was 8.8% among people between the age group of 20 and 79 years, which indicates almost 440 million people are affected by the problem. It is predicted that more than 550 million people will develop DM by the end of 2035 [3]. Different vascular and neural damages, including kidney disease, are attributable to DM that might pose danger in the renal capillaries and subsequently lead to the reduction of glomerular filtration rate (GFR) [4]. Once the kidney is damaged, it could not filter properly, and difficult to remove waste products that interfere with the normal physiological function of the body which progressively leads the body to shutdown [5]. CKD is a progressive loss of kidney function resulted from the vascular and neural complications of DM that incites several adults to death prematurely [4–7]. In the world, around 13.3 million people are affected by CKD yearly, of which 85% of the cases are from developing countries Approximately, 1.7 million annual deaths is ascribed to kidney disease [8]. The annual incidence of CKD among type-II diabetic patients ranges from 20-58/1000 [9–15]. Moreover, the time-to-occurrence of CKD (the time at which patients developed CKD since they diagnosed with type II DM) varies across different studies. The median occurrence time of CKD was around 3.8–12 years worldwide [9, 10, 16, 17]. In Africa, the incidence of CKD is estimated to be between 13.3–25% [18–21]. Particularly, in Sub Saharan Africa, the burden of CKD is much greater associated with additional risk factors like poverty, infections, low level of health literacy, and the high cost of medical fees for screening and treatment, that collectively aggravate the risk and progression of the problem with declined probability of survival [22, 23]. Ethiopia is one of the developing countries with a high burden of CKD due to the emerging of NCD associated with the swift changes in lifestyle [24]. About 10.4–19.1% of the population has exhibited CKD in the country [25–27]. The median time to develop CKD among type- (...truncated)