Time to Acute Kidney Injury and its Predictors among Newly Diagnosed Type 2 Diabetic Patients at Government Hospitals in Harari Region, East Ethiopia.

Lemma Demissie Regassa^1*, Yigzaw Kebede Gete², and Fantahun Ayenew Mekonnen ²

¹Haramaya University, Collage of Health and Medical Sciences, Ethiopia

² University of Gondar, Collage of Medicine and Health Sciences, Ethiopia

*Presenter

Email address

LDR - esraeldemiss@gmail.com YKG – gkyigzaw@yahoo.com

FAM – fantahunaye@gmail.com

Abstract

Introduction: The incidence of Acute Kidney Injury (AKI) among Type 2 DM significantly increasing with multiple consequences. The long standing diabetic before diagnosis and sub clinical nature of disease, prevent the early detection and prevention of acute kidney injury. Previous studies were mainly focusing on the admitted patients which may hinder the true nature of the acute kidney injury among T2D.  The aim of this study is to determine the time to acute kidney injury and its predictors among newly diagnosed type 2 DM patients on follow up from January 1, 2013 to December 31, 2017 in Government Hospitals of Harari Region.

Methods: This study was conducted in public Hospitals of Harari region retrospectively on the 502 newly diagnosed type two DM record from 2013 to 2017. Data was collected from the patients’ records by pre tested checklist. Quality of data was monitored from the beginning of data collection to the analysis stage. Data was entered using Epi info and analyzed in R software. Incidence was estimated and survival curves was compared between different exposure groups using Kaplan-Meier and log-rank test. Weibull regression models was used to determine the predictors and variables with p value less than 0.2 were fitted to multivariable model.

Results: Overall 14.5% (95%CI, 11.7-17.9) of the total study population was developed acute kidney injury. The total follow up time was 14409 parson-year. The incidence rate was about 6 per 100 PY with median survival time of 57 months. Significant predictors were Physical activity [Adjusted Time Ratio (ATR) 0.61, (95%CI, 0.49-0.75)], Congestive heart failure [ATR 0.84, (95%CI, 0.71-0.99)], Chronic kidney disease [ATR 0.77, (95%CI, 0.65-0.91)], Hypertension [ATR 0.78, (95%CI, 0.65-0.91)], Obesity [ATR 0.84, (95%CI, 0.74-0.96)], Diabetic nephropathy [ATR 0.80, (95%CI, 0.65-0.98)], Diuretics & Beta Blockers [ATR 0.85, (95%CI, 0.74-0.97)], and Delay initiation of follow up [ATR 0.97, (95%CI, 0.96-0.98)].

Conclusions and recommendations: Incidence of the acute kidney injury among type two diabetes mellitus was high. Physical activity, congestive heart failure, chronic kidney disease, hypertension, obesity, diabetic nephropathy, diuretics and delay for follow up were the predictors for the acute kidney injury. Identification and controlling comorbidities along with regular monitoring of kidney function is needed to prevent or delay the risk of acute kidney injury in type 2 diabetes.

Abbreviations and Acronyms

HR

Adjusted Hazard Rate

AKI

Acute Kidney Injury

CHF

Congestive Heart Failure

CI

Confidence Interval

DM

Diabetic Mellitus

T2D

Type Two Diabetes

PY

Person year