Evaluation of risk factors associated with nephropathy in type 2 diabetic patients in Rwanda

Abstract— Background: Diabetic nephropathy is an emerging clinical and public problem and is related with poor outcomes such as heart failure, and end stage renal disease. In the Rwanda countryside there are no recent studies on renal complications. Objective: To evaluate risk factors associated with nephropathy in Type 2 diabetic patients in Rwanda. Methods: A case-control study was conducted from January to September 2019 in four hospitals of Republic of Rwanda. Diabetic patients were screened for nephropathy by measuring microalbuminuria. Those with microalbuminuria were the cases and those patients free of nephropathy were the controls. The study sample had 592 participants, 83 cases and 509 controls enrolled. Plasma glucose was measured by enzymatic colorimetric test. HbA1c test was performed using the unique procedure of Bio -Rad Variant II. Albuminuria was measured by quantitative method using spectrophotometer. Total plasma cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, Urea and Creatinine were assayed by colorimetric methods using commercial kits. A questionnaire was used to assess other risk factors such as alcohol consumption, smoking, level of physical activity, family history of T2DM, obesity, stress, and demographic status. The data was analyzed on SPSS version 20. Statistical analysis was performed by Chi square to show association in nominal and ordinal data. Multivariate logistic regression analysis to select independent variables was performed. Odds ratio was used as measure of association. Results: In this study the prevalence of Diabetic nephropathy was 14%, (microalbuminuria was 12.5% and macroalbuminuria 1.5%). The major independent risk factors associated with diabetic nephropathy were male gender, long duration of type 2 diabetes (≥16 years), elevated HbA1c (> 7.5%) , poor adherence to diabetic medication, elevated creatinine (> 1.2 mg/dl), and lower level of education. Conclusion: Management of those modifiable risk factors of nephropathy could reduce its incidence in diabetic patients