Prevalence of Chronic Kidney Disease (CKD) in Type 2 Diabetes Mellitus Patients: START-India Study

Abstract

Objective: Despite rising incidence of diabetes in India, we currently lack country wide data on the prevalence of CKD in T2DM patients. Hence this nationwide study was planned.Methods: This was a nationwide, cross-sectional, observational, multi-centric study to assess prevalence of CKD among T2DM patients. The primary endpoint of the study was to estimate proportion of T2DM patients with CKD (glomerular filtration rate [GFR] <60 ml/min/1.73 m 2 or albumin creatinine ratio [ACR] ≥ 30 mg/g or ≥ 3 mg/mmol or both). The blood/plasma and urine samples, were collected for estimation of hemoglobin A1c, microalbuminuria, serum creatinine, urine creatinine, and routine urine analysis.Results: Of the 3043 screened subjects, 3000 eligible subjects were enrolled, out of which 46% were females. The mean age was 53.4 (± 11.9) years, with a mean body mass index of 27.3 (± 4.8) kg/m 2 . Both micro and macro vascular complications were reported. In the studied population with T2DM, 47.8% had mildly decreased, 15.1% had mild to moderately decreased, and 1.8% had severely decreased GFR respectively. As per ACR categorization, 61.3% had normal to mildly increased ACR, 25.6% with moderately increased and 7.2% with severely increased ACR were seen. We observed a significant (p<0.0001) weak negative correlation (-0.23069) between eGFR< 60 mL/ min/1.73 m² and urinary ACR in over six hundred patients. We found 48.4% prevalence of CKD in T2DM patients. The results on analysis of HbA1c goal achievement showed that the patients without CKD had a better success rate to achieve the target <7% goal of HbA1c compared to those who had CKD (29.6% vs. 23.4%). Conclusion:Study reported higher prevalence of CKD which was driven by the ACR levels and majority of the patients had reasonable eGFR. This can be a guide to select drug and dosage of diabetes drug as it depends on kidney function.

Chronic kidney disease-prevalence and determinants among type 2 diabetes mellitus patients attending a primary care setting in central Kerala

“…This is similar to the multi centric START study conducted among 3000 diabetic patients by Prasannakumar et al which reported a prevalence of 48.4%. 8 In a study done by Stanford et al on understanding CKD among patients with T2DM: prevalence, temporal trends and treatment patterns during 2007-2012 show overall CKD prevalence in the T2DM population to be 38.3%. 11 Most cases were mild-to-moderate CKD, with 9.1% for stage 1, 9.4% for stage 2 and 11.2% for stage 3a.…”

“…As per the START India multicentric study among type 2 diabetes mellitus patients conducted in 30 different sites in India, the prevalence of CKD among Type 2 Diabetes Mellitus patients was found to be 48.4%. 8 Taking this as 'p' and applying to the formula, Sample size, N = z α 2 pq / d 2 With absolute precision of 9.5%, which is less than acceptable 20% of p.…”

Effect of Age and Gender on Some Biochemical, Hormones and Adipocytokines Parameters in Iraqi Type 2 Diabetes Mellitus Patients

“…The data present in table (5) shows the effect of gender on glucose related parameters in T2DM patients. The findings revealed a significant (P<0.05) increase in levels of FBS in men compared with women, while no significant differences (P>0.05) were found in the levels of HbA1c, insulin and IR.…”

“…If not treated, and addressed medically, nephropathy progresses into chronic kidney disease (CKD). This association of T2DM and CKD complicates the treatment of T2DM clinically 5 . Serum urea and creatinine are known to be raised with hyperglycemia in uncontrolled diabetics and usually correlate with severity of kidney damage.…”

“…The reduction in serum calcium level in type 2 diabetes mellitus is most probably due to hyperglycemia which increases calcium and phosphorus excretion in urine which is proportional to the degree of glucosuria, hypercalciuria by osmotic diuresis caused stimulation of bone resorption caused by secondary hyperparathyroidism 6 . In response to urinary calcium loss, PTH secretion is mildly but significantly stimulated to maintain serum calcium concentrations 5 . Phosphorus is an element that plays an important role in many physiologic systems.…”