Prevalence of and Factors Associated with Nephropathy in Diabetic Patients Attending an Outpatient Clinic in Harare, Zimbabwe

• Published in: The American journal of tropical medicine and hygiene 2017-02, Vol.96 (2), p.477-482
• Main Authors: Machingura, Pasipanodya Ian, Chikwasha, Vasco, Okwanga, Parmenas Nelson, Gomo, Exnevia
• Format: Article
• Language: English
• Subjects: Adult; Aged; Albumins - analysis; Albuminuria - epidemiology; Ambulatory Care Facilities - statistics & numerical data; Creatinine - blood; Cross-Sectional Studies; Developing Countries; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Nephropathies - epidemiology; Diabetic Nephropathies - etiology; Female; Humans; Male; Middle Aged; Prevalence; Risk Factors; Zimbabwe - epidemiology
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.15-0827

There is limited information on the burden of diabetic nephropathy in developing countries. This study aimed to determine the prevalence of and factors associated with nephropathy among diabetic patients attending an outpatient clinic in Harare, Zimbabwe. In an analytical cross-sectional study, diabetic patients were consecutively enrolled and a questionnaire administered, clinical assessment conducted, and blood samples collected for human immunodeficiency virus testing and measurement of lipids, creatinine, fructosamine, and glycosylated hemoglobin levels. Urine samples were collected for determination of albumin and creatinine levels, which were used to categorize albuminuria. A total of 344 diabetic patients were enrolled. Overall, just over a third (35.8%) of patients had moderately increased albuminuria and 9.0% had severely increased albuminuria giving an overall prevalence of nephropathy of 44.8%. Prevalence of moderately increased albuminuria was slightly higher (36.5% versus 33.3%) and severely increased albuminuria slightly lower (8.8% versus 9.5%) in type 2 than type 1 diabetes patients, but the difference was not statistically significant ( = 0.866). Higher fructosamine and retinopathy were associated with nephropathy in both univariate and multivariate analysis {higher fructosamine (odds ratio [OR] = 1.00, confidence interval [CI] = 1.00-1.01), and retinopathy (OR = 2.80, CI = 1.64-4.97)}. We report a higher prevalence of moderately increased albuminuria and a lower prevalence of severely increased albuminuria compared with findings reported a decade ago among type 1 and type 2 diabetes mellitus patients attending the same clinic. High fructosamine and retinopathy were independent predictors of nephropathy.