Prevalence and Management of Renal Impairment in Adults with Type 2 Diabetes Mellitus in specialized diabetes clinics in Primary Care in the Kingdom of Bahrain

Abstract

Introduction: Diabetes nephropathy is a consequence of Diabetes Mellitus (DM) and is a leading cause of EndStage Renal Disease (ESRD). Diabetes nephropathy is a metabolic disease and can be prevented through the proper monitoring of glycaemic control levels and kidney function, which is done using estimated glomerular filtration rate (eGFR). There is a sparsity of data addressing diabetes nephropathy in the Kingdom of Bahrain; hence, this research was undertaken to the prevalence of diabetes nephropathy in Bahrain, its associated risk factors, and clinical management practices. Methodology: A retrospective cross-sectional study took place in the central diabetes clinics (CDCs) of seven primary healthcare units (PHUs) in Bahrain, for the period from February to April 2020. Inclusion criteria included type 2 diabetes patients, aged 18 years and above, following up with the CDCs during the period from February to April 2020. The exclusion criteria included type 1 diabetes patients, patients under the age of 18, patients with renal transplants, and pregnant women. Other variables included demographic data, biochemical and clinical data, e-GFR, albuminuria status, medication prescriptions, and secondary care nephrology referrals. Results: A total of 2,125 patients were enrolled in the study, with 16.3% suffering from chronic kidney disease at stages 3, 4 and 5. Strong correlations were found between low eGFR and certain variables, including HbA1c, blood pressure and age. A multivariate logistic regression analysis revealed that increased age, HbA1c, and systolic blood pressure were associated with a higher risk of an eGFR of less than 60 mL/min/1.73 m2 . Conclusion: This study highlighted that the prevalence of renal impairment in people with DM in Bahrain is high with a detrimental economic impact. Further studies with longitudinal patterns need to be performed to verify the true impact of this illness.