Chronic kidney disease in type 2 diabetes: Identifying key risk factors from Johor national diabetes registry study.
Chronic kidney disease (CKD) is a common and important complication among patients with, contributing to substantial morbidity and adverse clinical outcomes. This study aimed to determine the factors associated with CKD among patients with T2DM in Johor, Malaysia.
This was a registry-based crosssectional study using secondary data from the Malaysian National Diabetes Registry (NDR). The study included patients with T2DM captured in the Johor NDR during the 2020-2021 audit cycle. CKD status was determined by calculating the estimated glomerular filtration rate (eGFR) using the CKD Epidemiology Collaboration (CKD-EPI) formula based on serum creatinine and relevant patient variables extracted from the registry. Patients were operationally classified as having CKD if the available registry-derived eGFR was <60 mL/min/1.73 m². Sociodemographic, clinical, biochemical, diabetes-related complication, and medication-related variables were analysed. Univariate analysis was performed using Chisquare test or Fisher's exact test, and variables with p<0.05 were entered into multivariable logistic regression to identify factors independently associated with CKD among patients with T2DM.
A total of 10,117 patients with T2DM were included, of whom 2,387 (23.6%) had CKD. Factors independently associated with CKD were age ≥60 years (aOR: 2.97, 95% CI: 2.60, 3.38), hypertension (aOR: 1.37, 95% CI: 1.10, 1.70), diabetes duration >10 years (aOR: 1.84, 95% CI: 1.58, 2.14), abnormal triglyceride (aOR: 1.59, 95% CI: 1.42, 1.79), abnormal high-density lipoprotein (HDL) (aOR: 1.26, 95% CI: 1.13, 1.40), diabetic retinopathy (aOR: 1.22, 95% CI: 1.06, 1.40), cerebrovascular disease (aOR: 1.40, 95% CI: 1.06, 1.85), and diabetic foot ulcer (aOR: 2.40, 95% CI: 1.68, 3.41). Medication-related associations were observed but should be interpreted cautiously because of potential confounding by indication and reverse causation.
CKD affected nearly one-quarter of patients with T2DM in this Johor registry-based study. Older age, hypertension, longer diabetes duration, lipid abnormalities, diabetic retinopathy, cerebrovascular disease, and diabetic foot ulcer were independently associated with CKD. These findings provide useful real-world evidence to support earlier risk identification and future development of a locally derived CKD risk prediction model among Malaysian patients with T2DM.
This was a registry-based crosssectional study using secondary data from the Malaysian National Diabetes Registry (NDR). The study included patients with T2DM captured in the Johor NDR during the 2020-2021 audit cycle. CKD status was determined by calculating the estimated glomerular filtration rate (eGFR) using the CKD Epidemiology Collaboration (CKD-EPI) formula based on serum creatinine and relevant patient variables extracted from the registry. Patients were operationally classified as having CKD if the available registry-derived eGFR was <60 mL/min/1.73 m². Sociodemographic, clinical, biochemical, diabetes-related complication, and medication-related variables were analysed. Univariate analysis was performed using Chisquare test or Fisher's exact test, and variables with p<0.05 were entered into multivariable logistic regression to identify factors independently associated with CKD among patients with T2DM.
A total of 10,117 patients with T2DM were included, of whom 2,387 (23.6%) had CKD. Factors independently associated with CKD were age ≥60 years (aOR: 2.97, 95% CI: 2.60, 3.38), hypertension (aOR: 1.37, 95% CI: 1.10, 1.70), diabetes duration >10 years (aOR: 1.84, 95% CI: 1.58, 2.14), abnormal triglyceride (aOR: 1.59, 95% CI: 1.42, 1.79), abnormal high-density lipoprotein (HDL) (aOR: 1.26, 95% CI: 1.13, 1.40), diabetic retinopathy (aOR: 1.22, 95% CI: 1.06, 1.40), cerebrovascular disease (aOR: 1.40, 95% CI: 1.06, 1.85), and diabetic foot ulcer (aOR: 2.40, 95% CI: 1.68, 3.41). Medication-related associations were observed but should be interpreted cautiously because of potential confounding by indication and reverse causation.
CKD affected nearly one-quarter of patients with T2DM in this Johor registry-based study. Older age, hypertension, longer diabetes duration, lipid abnormalities, diabetic retinopathy, cerebrovascular disease, and diabetic foot ulcer were independently associated with CKD. These findings provide useful real-world evidence to support earlier risk identification and future development of a locally derived CKD risk prediction model among Malaysian patients with T2DM.
Authors
Khebir Khebir, Razak Razak, Ismail Ismail, Abdul Hafidz Abdul Hafidz, Ismail Ismail, Isa Isa
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