Diabetes and Chronic Kidney Disease in Turkey (DIAKIT): A Cross-Sectional Cohort Study

Abstract

Background Chronic kidney disease (CKD) is a global public health problem with increasing disease burden affecting nearly 10% of adult population worldwide. We aimed to detect the prevalence of CKD, patients' distribution among CKD stages, and factors associated with having CKD in diabetic patients in Turkey. Methods This cross-sectional study, conducted in 2022, included 1591 patients with diabetes (mean age, 63 +/- 10 years; female: 65.5%) from the Cappadocia Cohort study. CKD was diagnosed by an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) or urinary albumin-to-creatinine ratio (UACR) >= 30 mg/g, which was measured in spot urine samples collected in the morning for three consecutive days. Results In this cohort of adult diabetic patients, the prevalence of CKD was 25.1%. More than half of the diabetic patients with CKD (53.8%) had albuminuria without a decrease in eGFR, 28.1% had decreased eGFR without albuminuria, and 18.2% had both albuminuria and decreased eGFR. While the percentage of CKD patients who are female vs. male was 60% vs. 40%, CKD prevalence was higher in males (29.2%) than in females (22.9%) (P = 0.007). Among patients with CKD, only 9.4% were aware that they had CKD. Age, male sex, HbA1c, triglyceride, uric acid, C-reactive protein, and hypertension Grade 1, 2 and 3 were associated with the presence of CKD, with uric acid showing the strongest association. Conclusions More than half of our patients with CKD would not have been diagnosed if urinary albumin excretion was not measured. Early detection of CKD by regular screening of diabetic patients using both UACR and eGFR measurements is essential for early diagnosis and prompt treatment to slow down disease progression.