Renal failure in Tunisian patients with type 2 diabetes: Frequency and related factors

Authors

  • Chiraz Bouzid
  • Hajer Smida
  • Anissa Kacem
  • Zinet Turki
  • Leila Ben Salem
  • Chiheb Ben Rayana
  • Claude Ben Slama

Keywords:

Renal failure, diabetic nephropathy, type 2 diabetes, risk factors

Abstract

Background: Frequent screening of renal failure and good glycaemic control in diabetic patients can avoid this severe complication.
Aim: To evaluate the frequency of renal failure and the associated risk factors among type 2 diabetic Tunisian in-patients. Glomerular filtration rate was estimated using the Cockcroft-Gault formula.
Renal failure was diagnosed on figure of glomerular filtration rate inferior than 60 ml/min.
Results: Six hundred eighty-nine patients were included. The sex ratio was 0.65. The mean age was 60 ± 11 years. The frequency of renal failure was 19.8% (137 patients) with dominance of a moderate form defined by a glomerular filtration rate between 30 and 59 ml/min (82.5% of patients). Patients with renal failure were older and less obese than diabetic patients without this complication (p<0.00001 and 0.02 respectively). The duration of both diabetes and hypertension was higher in presence of renal failure (p=0.0001 and p<0.001 respectively). Patients with renal failure had more often hypertension and dyslipidemia than patients with normal renal function (p<0.001 and p=0.01 respectively). A personal history of severe retinopathy treated by laser, of coronary disease or of stroke was significantly associated to renal failure (p=0.002, p<0.0001 and p=0.001 respectively).
Conclusion: The frequency of renal failure observed in Tunisian patients diagnosed with type 2 diabetes is high. Hypertension and dyslipidemia should be carefully treated to prevent or delay the evolution to the renal failure.

Downloads

Download data is not yet available.

References

Counil E, Cherni N, Kharrat M, Achour A, Trimech H. Trends of incident dialysis patients in Tunisia between 1992 and 2001. Am J Kidney Dis 2008; 51: 463-7.

Abderrahim E, Zouaghi K , Hedri H, et al. Renal replacement therapy for diabetic end-stage renal disease. Experience of a Tunisian hospital centre. Diabetes Metab 2001; 27: 584-90.

Couchoud C, Campagna A. F. Diabète et insuffisance rénale terminale en 2006. Néphrol Ther 2008; 4 Suppl 2: S157-S160.

Papoz L, Ben Khalifa F, Eschwege E, Ben Ayed H. Diabetes mellitus in Tunisia: Description in urban and rural populations. Int J Epidemiol 1988; 17: 419-422.

Bouguerra R, Alberti H, Ben Salem L, et al. The global diabetes pandemic: the Tunisian experience. Eur J Clin Nutr 2007; 61: 160-5.

Remuzzi G, Ruggenenti P, Perico N. Chronic renal diseases: Renoprotective benefits of renin-angiotensin system inhibition. Ann Intern Med 2002; 136: 604?15.

Riegersperger M, Sunder-Plassmann G. How to prevent progression to end stage renal disease. J Ren Care 2007; 33: 105-7.

Farnier M. Dyslipidémies du diabétique. Paris: John Libbey Eurotext; 2002. p. 45-46.

Frimat L, Loos-Ayav C, Panescu V, Cordebar N, Briançon S, Kessler M. Early referral to a nephrologist is associated with better outcomes in type 2 diabetes patients with end-stage renal disease. Diabetes Metab 2004; 30: 67-74.

American diabetes association. Standards of Medical Care in Diabetes—2009 Diabetes care 2009; 32 (Suppl 1): S28.

Alberti KGMM, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome — a new worldwide definition. Lancet 2005; 366: 1059-62.

Cockroft D, Gault M. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31-41.

Levey AS, Coresh J, Balk E, et al. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Ann Intern Med 2003; 139: 137-47.

Harzallah F, Alberti H, Kanoun F, Elhouch F, Slimane H. Quality of care of patients with type 2 diabetes in a Tunisian university hospital. Diabetes Metab 2004; 30: 523-26.

Narentipak S, Narentipak A. Prevalence of chronic kidney disease in type 2 diabetes in primary health care unit of Udon Thani province, Thailand. J Med Assoc Thai 2008; 91:1505-13.

Lu B, Songa X, Donga X, et al. High prevalence of chronic kidney disease in population-based patients diagnosed with type 2 diabetes in downtown Shanghai. J Diabetes Complications 2008; 22: 96-103.

Sasso FC, De Nicola L, Carbonara O, et al. Cardiovascular risk factors and disease management in type 2 diabetic patients with diabetic nephropathy. Diabetes Care 2006; 29: 498-503.

Tranche I S, Riesgo GA, Marin IR, Diaz G, Garcia FA. Prevalence of "hidden" renal failure in the population suffering from type-2 diabetes [abstract]: Atencion Primaria 2005; 35: 359-64.

Levey AS, Coresh J, Green T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F . Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247 - 254.

Levey AS, Bosh JP, Lewis JB, Green T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine : a new prediction equation .Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461 - 70.

Helou R. Should We Continue to Use the Cockcroft-Gault Formula? Nephron Clin Pract 2010: 116; c 172 - c 186.

Trivalle C. Gérontologie préventive. Eléments de prévention du vieillissement pathologique. Paris: Masson; 2002. p 299.

Kramer H J, Nguyen QD, Curhan G, Hsu C Y. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA 2003; 289: 3273-7.

UK Prospective Diabetes Study (UKPDS) Group: Intensive bloodglucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-53.

Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O. Obesity and risk for chronic renal failure. J Am Soc Nephrol 2006; 17: 1501-2.

Luc G, Lecerf JM. Les dyslipidémies. Paris: Masson; 2002. p. 108- 109.

Orth SR. Smoking: A renal risk factor. Nephron 2000; 86: 12-26.

Stephan RO, Stein IH. Smoking: A risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients — Absence of evidence or evidence of absence? Clin J Am Soc Nephrol 2008; 3: 226-36.

Colhoun HM, Lee ET, Bennett PH, et al. Risk factors for renal failure: the WHO Mulinational Study of Vascular Disease in Diabetes. Diabetologia 2001; 44 Suppl 2: S46-53.

DCCT Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications. Kidney Int 1995; 47: 1703-20.

The ADVANCE Collaborative Group. Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2008; 358: 2560-72.

Roussel R, Hadjadj S, Marre M. Néphropathie diabétique. In Grimaldi A. Traité de diabétologie. Paris: Flammarion; 2005. p. 556-69.

Parving HH, Mogensen CE, Thomas MC, Brenner BM, Cooper M.E. The RENAAL study investigators. Poor prognosis in proteinuric type 2 diabetic patients with retinopathy: insights from the RENAAL study. Q J Med 2005; 98: 119-26.

Culleton BF, Larson MG, Wilson PW, Evans JC, Parfrey PS, Levy D. Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int 1999; 56: 2214-19.

Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascularoutcomes after myocardial infarction. N Engl J Med 2004; 351: 1285-95.

Nag S, Bilous R, Kelly W, Jones S, Roper N, Connolly V. All-cause and cardiovascular mortality in diabetic subjects increases significantly with reduced estimated glomerular filtration rate (eGFR): 10 years' data from the South Tees Diabetes Mortality study. Diabet Med 2007; 24: 10-17.

Downloads

Published

2011-01-11

Issue

Section

Original articles